Last updated on:August 21st, 2021
You’re looking at an interactive case study from Prognosis: Your Diagnosis (one of four distinct learning formats available in Clinical Odyssey). Try it out, and have fun improving your clinical skills.
A 48-year-old man presents with fever for one week, which was initially low grade and intermittent, but then became high-grade yesterday. He also complains of a dull ache in the upper left abdomen for the same duration. No other symptoms are present.
His medical history is significant for type 2 diabetes mellitus for eight years, with poor control, limited dietary compliance and only occasional follow-up. The presence of diabetic complications is unknown.
He also experienced an episode of cystitis around one month ago, for the first time in his life. This resolved with antibiotic therapy. He defaulted on the follow-up and has not been evaluated for abnormalities of the urinary tract.
He is currently on Metformin 850 mg OD and Gliclazide 30 mg OD. There are known allergies. He does not smoke, but drinks socially. There is no history of intravenous drug abuse.
His basic bloodwork reveals a leukocyte count of 16,500/mm3, with 90% neutrophils, a capillary blood sugar of 225 mg/dL (12.5 mmol/L), and normal blood urea and serum creatinine levels.