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Clinical Problem-Solving

Just Beneath the Surface

List of authors.
  • Catherine Handy Marshall, M.D., M.P.H.,
  • Jordan Nahas-Vigon, M.D.,
  • Reza Manesh, M.D.,
  • and Allan C. Gelber, M.D.

A 55-year-old man presented with intermittent fevers and fatigue after returning from a 5-month visit to Pakistan. He had no night sweats, weight loss, headache, cough, diarrhea, rash, dysuria, or arthralgias.

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Funding and Disclosures

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

No potential conflict of interest relevant to this article was reported.

We thank Richard F. Ambinder, M.D., for review of an earlier version of the manuscript; and the Jeremiah A. Barondess Fellowship in the Clinical Transaction of the New York Academy of Medicine, in collaboration with the Accreditation Council for Graduate Medical Education.

Author Affiliations

From the Osler Medical Service, Johns Hopkins Hospital (C.H.M., J.N.-V., R.M., A.C.G.), and the Departments of Medicine (C.H.M., J.N.-V., R.M., A.C.G.) and Oncology (C.H.M.), Johns Hopkins University School of Medicine — both in Baltimore.

Address reprint requests to Dr. Handy Marshall at the Department of Oncology, Johns Hopkins University School of Medicine, 1650 Orleans St., Suite 186, Baltimore, MD 21287, or at .

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