Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 17, Number 6, June 2026, pages 251-257

Prolonged Fever of Unknown Origin With Suspicion of Adult-Onset Still’s Disease: A Diagnostic Challenge

Figure

↓  Figure 1. Timeline demonstrating all ED visits, admissions, laboratory/imaging diagnostic tests, and consultations from the first ED presentation to the most recent outpatient follow-up. ED: emergency department; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; ID: infectious disease; CT: computed tomography; RPR: rapid plasma reagin; EBV: Epstein–Barr virus; HIV: human immunodeficiency virus; SPEP: serum protein electrophoresis; TURP: transurethral resection of the prostate; ANA: antinuclear antibody; ANCA: anti-neutrophil cytoplasmic antibody; WBC: white blood cell; PCR: polymerase chain reaction; PET: positron emission tomography.
Figure 1.

Table

↓  Table 1. All Pharmacological Treatments the Patient Received Since the Initial ED Presentation, Including Name of Treatment, Dose, Route, Frequency, and Duration of the Course
 
Time from initial presentationPharmaceutical treatmentDose/route/frequencyCourse
ED: emergency department; IV: intravenous; IVPB: intravenous piggyback.
About 1 monthErtapenem1,000 mg IV every 24 h7 days
Piperacillin/tazobactam4.5 g in NaCl 0.9% 100 mL IVPBOnce
Cefepime2,000 mg/50 mL IVPBOnce
Vancomycin1,000 mg IV every 12 h5 days
Ciprofloxacin400 mg IV every 12 h3 days
Ampicillin2,000 mg IV every 6 h3 days
About 2 monthsVancomycin1,500 mg IV every 18 h5 days
Daptomycin8 mg/kg IV every 24 h11 days
Vancomycin1,500 mg IV every 18 h2 days
1,000 mg IV every 12 h18 days
Azithromycin500 mg oral daily3 days
Levofloxacin500 mg oral daily13 days
About 3 monthsMeropenem1,000 mg IV every 8 h11 days
Doxycycline100 mg oral twice daily20 days
Levofloxacin500 mg oral daily15 days
About 4 monthsVancomycin1,000 mg IV every 12 h3 days
Ceftriaxone2,000 mg IV every 24 h3 days
About 5 monthsCeftriaxone2,000 mg IV every 24 h3 days
Prednisone40 mg oral daily4 days
20 mg oral daily7 days
About 6 monthsPiperacillin/tazobactam4.5 g in NaCl 0.9% 100 mL IVPBOnce
Vancomycin1,500 mg IV every 24 h4 days
Cefepime2,000 mg IV every 8 h4 days
Prednisone30–40 mg oral dailyOngoing
About 7 monthsTocilizumab4 mg/kg IV every 4 weeksOngoing