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Endgames Case Review

Unresolving fever, headache, cough, and negative covid-19 PCR result

BMJ 2022; 377 doi: (Published 11 May 2022) Cite this as: BMJ 2022;377:e068645
  1. Nina Xie, resident12,
  2. Yafang Zhou, resident12
  1. 1Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
  2. 2National Clinical Research Centre for Geriatric Disorders, Changsha, Hunan 410078, China
  1. Correspondence to: Y Zhou zyf_1981{at}

A previously well man in his 60s presented with a 10 day history of fever, headache, cough, malaise, and lethargy. The headache was recurrent, severe, throbbing, and of no fixed localisation. The cough was mostly dry, with occasional production of orange-brown sputum. The patient had failed to respond to treatment with piperacillin-tazobactam for three days and was referred to the department for the care of older people. Two weeks earlier he had been plucking feathers from chickens on his farm that had been feverish, dishevelled, and lost weight. The result of a polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. The patient reported no recent travel to areas where other fever related diseases are endemic.

For the past 40 years he had consumed about 50 cigarettes monthly and 0.5 units of alcohol daily. On examination, his temperature was 40.3°C, heart rate 115 beats/min, respiratory rate 22 beats/min, blood pressure 124/72 mm Hg, and oxygen inhalation (2 L/min), with oxygen saturation varying between 93% and 96%. On auscultation, rales were evident in the right lung. The patient was alert and oriented with no signs suggestive of meningeal irritation. Table 1 …

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