Case example: Fever of Unknown Origin Diagnosed in ER but Disregarded after Admission
In this case, when the patient was admitted to the hospital, the emergency department had correctly described her presentation as “fever of unknown origin” commonly referred to “FUO.”
The presenting complaint of “fever of unknown origin” commonly referred to as “FUO” requires a very specific differential diagnosis that should have included exotic and opportunistic infections including tuberculosis. Tragically, after she was admitted to the ICU, the patient’s condition was incorrectly attributed to an autoimmune disorder. The patient died as a result of complications secondary to tuberculosis twenty-six days later.
Months after her death when I was asked to investigate the case, the story the hospital told her husband seemed implausible: a twenty-nine year old otherwise healthy woman shouldn’t die from a lupus flare following a twenty-six day hospitalization. Making things more difficult, there was no autopsy. But we found buried in the record a positive test for acid-fast bacilli that held the key to the case and worked backwards to prove the patient’s symptoms from the outset were from tuberculosis, not lupus.
Despite her presenting complaint of FUO, history of treatment with prednisone, country of origin (where TB is endemic), and persistent fever, she was never asked about her history of TB exposure. An individual can be infected by TB and have no symptoms, so long as their immune system remains healthy. The hospital and its physicians vigorously defended the case and their care. A few days before jury selection, the hospital agreed to a settlement that will help her widow and children, devastated by their loss, gain a measure of financial security.
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