An unusual cause of fever of unknown origin with enlarged lymph nodes—relapsing polychondritis: A case report

Liu, Wei; Jiang, Hongli; Jing, Han; Mao, Bing

Comprehensive diagnostic workup were continued during hospitalization and revealed evidence of increased erythrocyte sedimentation rate (63 mm/h, reference range [RR] < 21 mm/h), mild anemia (hemoglobin 11.1 g/dL, [RR] 13-17.5 g/dL), mild hypoalbuminemia (ALB 38.5 g/L, [RR] 40.0-55.0 g/L), thrombocythemia (391 Â 10 9 /L, [RR] 100-300 Â 10 9 /L), high level of procalcitonin (0.24 ng/mL, [RR] < 0.046 ng/mL), C-reactive protein (10.7 mg/dL, [RR] < 0.5 mg/dL), and interleukin-6 (44.12 pg/mL, [RR] 0.00-7.00 pg/mL). White blood cell count, tumor biomarkers investigation, serology detections on viral infections (HIV, syphilis, hepatitis viruses, influenza viruses, PIV, ADV, CMV, BOV, RHV, RSV, EBV, metapneumovirus, and coronavirus), and zoonoses (tuberculosis, Brucella spp., Rickettsia spp., Coxiella burnetii, Leishmania spp., Clonorchis sinensis, plasmodiosis, schistosomiasis japonica, Echinococcosis, Chlamydiosis, MPP, toxoplasmosis, and leptospirosis), complements 3 and 4, rheumatoid factor, autoimmune antibodies (antinuclear antibody, antidouble-strand DNA antibody, anti-RNP antibody, anti-SM antibody, anti-SSA/B antibody, anti-SCL-70 antibody, anti-Jo-1 antibody, anti-RIB antibody, and antineutrophil cytoplasmic antibodies) all yielded normal results. No bacterial and fungal pathogens were cultured from blood, sputum, bone marrow, or bronchial alveolar lavage fluid. Bone marrow biopsy and aspiration gave negative results in cytological smear and flow cytometry. Interferon-gamma-release assay (IGRA) testing for tuberculosis was also negative. His abdomen was innocent. Enhanced computed tomography (CT) of the chest showed intumescence of bilateral cervical and right supraclavicular lymph nodes, and pulmonary emphysema with bilateral multiple small nodules (0.3-0.5 cm) (Fig. 1) . Biopsy specimens taken from the right supraclavicular lymph node for histopathological study showed nonspecific inflammation with cellular infiltrates of lymphocytes and plasma cells.