Pyrexia of Unknown Origin: A Perplexing Case

Abstract

Pyrexia of Unknown Origin (PUO) is a common diagnostic dilemma in the medical wards. We present the case of a 64-year-old man who had presented with fever, fatigue, dry cough and bloody diarrhea. Over the next few days, he developed severe testicular pain and renal failure. Blood results revealed anaemia, raised ESR, negative ANA and negative ANCA. Renal biopsy showed crescentic glomerulonephritis. Repeat value of c-ANCA was positive which clinched the diagnosis of Granulomatosis with Polyangiitis (GPA). We present this case in order to illustrate the masquerading nature of the vasculitic syndromes and to emphasise the need to integrate clinical and laboratory clues to reach a diagnosis.

Keywords

• crescentic glomerulonephritis
• polyangiitis
• vasculitis