Tennessee medicine : journal of the Tennessee Medical Association
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West Nile Virus (WNV), a flavivirus, was first documented in the United States by the Center for Disease Control in 1999. WNV has been associated with a variety of clinical features from a subclinical febrile illness to a neuroinvasive disease. Rhabdomyolysis, however, has not been a clinically well-described occurrence during WNV illness. ⋯ During his illness, creatinine kinase (CK) values peaked at 45,276 U/L. We discuss the temporal relationship of the development of rhabdomyolysis, the course of his paralytic illness, imaging results, and present supporting evidence that rhabdomyolysis was not a sequel of another clinical condition. With the increasing spread of WNV, it is important to recognize rhabdomyolysis and flaccid paralysis as important manifestations of neuroinvasive WNV infection.
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A 29-year-old black male had multiple hospital admissions for fever (101 degrees F-104 degrees F) of unknown origin. Over six months, the patient had a constellation of symptoms, including pleuritic chest pain, dry cough, arthralgias of hand joints and marked constitutional symptoms including weigh loss. Patient had erythema nodosum, generalized lymphadenopathy, multiple subcutaneous nodules over the epigastric region and a nodule in his left eye. ⋯ Despite a broad spectrum of empiric antibiotics, the patient was having a daily spike of temperature. A left supraclavicular lymph node biopsy showed small non-caseating granuloma typical for sarcoidosis. This patient had fever of unknown origin secondary to a sub acute form of sarcoidosis, with marked constitutional symptoms, bilateral hilar and mediastinal lymphadenopathy, erythema nodosum, and arthralgias--a setof findings sometimes referred to as Lofgren's syndrome.