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In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.
A 26-year-old woman with end-stage renal disease from primary membranoproliferative glomerulonephritis presented with a two-week history of intermittent fever, with temperatures as high as 39°C. She had received her second cadaveric renal transplant 11 months previously.
Disease categories to consider in a febrile patient who has received a transplanted organ include infection, rejection, a post-transplantation lymphoproliferative disorder, and the reappearance of an
Commentary
Source Information
From the Department of Pediatrics, University of Michigan Medical School, Ann Arbor (U.D.P.); the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco (H.H.); and the Department of Veterans Affairs Health Services Research and Development Center of Excellence, and the Department of Internal Medicine, University of Michigan both in Ann Arbor (U.D.P., S.S.).
Address reprint requests to Dr. Patel at the University of Michigan, Robert Wood Johnson Clinical Scholars Program, 6312 Medical Sciences Bldg. I, 1150 W. Medical Center Dr., Ann Arbor, MI 48109-0604, or at patelu@umich.edu.
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