Case 5-2000

Presentation of Case A 35-year-old man was admitted to the hospital because of a painful abdominal mass and fever. The patient was a native of West Africa who had traveled to the United States several times during the previous three years. He had been generally well except for an episode of typhoid fever five years before admission and multiple bouts of malaria over a number of years; the most recent bout occurred three months before admission. Thirty days before admission, he returned to this country. Three or four days later, fever developed, and his temperature rose to 39.4°C, with shaking . . .