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A 62-year-old man presented to the emergency department (ED) with 3 days of chills, myalgias, and nausea. The patient’s oral temperature at home ranged from 99.9 to 100.1 °F. He came to the ED after multiple phone discussions with primary care nursing over 3 days. His medical history included posttraumatic stress disorder, enlarged prostate, osteoporosis, gastroesophageal reflux, glaucoma, and left eye central retinal vein occlusion. Medications included fluoxetine 20 mg twice daily, omeprazole 20 mg twice daily, rosuvastatin 10 mg once daily, tamsulosin 0.4 mg nightly, and zolpidem 10 mg nightly. The patient’s glaucoma had been treated with a dexamethasone intraocular implant about 90 days earlier. The patient started on intravenous (IV) zoledronic acid for osteoporosis, with the first infusion 5 days prior to presentation.
In the ED, the patient’s temperature was 98.2 °F, blood pressure was 156/76 mm Hg, pulse was 94 bpm, respiratory rate was 16 breaths per minute, and 98% oxygen saturation on room air. He was in no acute distress, with an unremarkable physical examination reporting no abnormal respiratory sounds, no arrhythmia, normal gait, and no focal neurologic deficits. A comprehensive metabolic panel was unremarkable, creatine phosphokinase was 155 U/L (reference range, 30-240 U/L), and the complete blood count was notable only for an elevated white blood count of 15.3 × 109/L (reference range, 4.0-11.0 × 109/L), with 73.4% neutrophils, 16.2% lymphocytes, 9.1% monocytes, 0.5% eosinophils, and 0.4% basophils. The patient’s urinalysis was unremarkable.
