Shapiro's Syndrome: A Renewed Appreciation for Vital Signs

Vital signs are an invaluable diagnostic tool, but in this era of modern medicine and expensive tests, important information obtainable at the patient’s bedside is often overlooked. We report an unusual case, Shapiro’s syndrome, in which an appreciation of temperature recordings was essential to diagnosis. We review this disorder and the thermoregulatory system. A previously healthy 49-year-old man from a small Midwestern town was admitted to the hospital in midautumn with complaint of bed-shaking chills and drenching sweats of up to 90 min duration, occurring every 4–6 h for the previous month. These episodes eventually exhausted the patient to the point of incapacitation. He was admitted to a local hospital 3 weeks into his illness, where an exhaustive laboratory and radiological work-up was unrevealing. He was subsequently transferred to our tertiary referral center for further evaluation and specifically placed under the care of the infectious diseases service because of the shaking chills. The patient had no other complaints, except for a 33-kg weight loss over the past month. His medical, surgical, and family histories were unremarkable. He was receiving no medication before the onset of symptoms and had no allergies to medication. He worked as a custodian in a food warehouse. Social and travel histories were otherwise unremarkable.