A 28-year-old male complains of fever 101 to 103 degrees for the last week. He reports fatigue, no appetite, sore throat, 7-pound weight loss in the last week, and two episodes of nosebleeds
The patient reports no medical problems and no current medications. Surgical history is tonsillectomy at five years old. Paternal family history of hypertension and diabetes; father alive age 50. Maternal history: no significant disorders. Denies use of tobacco, "occasional alcohol use" on weekends. Denies unsafe sex. No recent travel. On review of systems, night sweats and dyspnea on exertion are noted. Which of the following should be considered in the differential diagnosis?
A. HIV infection
B. Malignancy
C. Thrombocytopenia
D. Tuberculosis
ANS: B
Many malignancies can cause fever, but lymphoma and leukemia should be at the top of the differential list. Acute leukemia is more common in children, and the chronic leukemias are more common in middle-aged to elderly adults. Hodgkin's lymphoma is more prevalent in children and young adults, although the peak for incidence is bimodal and can be seen in patients over the age of 60. Non-Hodgkin's lymphoma is more common in middle-aged to elderly adults. Burkitt's lymphoma is more common in HIV patients. With leukemia, common symptoms include unexplained fever, easy bruising or bleeding, fatigue, bone or joint pain, and enlarged liver or spleen. With lymphoma, common symptoms include fatigue, fever, night sweats, lymphadenopathy, and weight loss.
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