Due to the advances in imaging and diagnostic procedures, differential diagnoses for fever of unknown origin can usually be narrowed down. However, when a patient does present with fever and no clear origin, it is truly a challenge to locate the inflammation or infection in a timely manner so that focused treatment can be employed.

You are the AGACNP hospitalist provider tasked with admitting the following patient to the hospital. The patient is:

1. A 40-year-old, Hispanic, developmentally delayed, female from a local long-term care center with early dementia, DM-2 (insulin dependent), neurogenic bladder, hypertension, and systolic dysfunction (EF 30%) due to ischemic cardiomyopathy.
2. Brought by emergency medical transport to the emergency department with altered mental status and the following vital signs: oral temp is 101.5, HR 72, RR=28, and oxygen saturation on room air is 88%.
3. Currently on prednisone 20 mg daily for temporal arteritis, and Coreg 12.5 mg BID, Namenda 10 mg daily, Lasix 40 mg daily, Levemir 20 units SQ BID, metformin 500 mg BID, and sliding scale insulin.

Explain the presentation, etiology, risk factors, common differential diagnosis, typical diagnostic work-up, treatment plan (based on current clinical guidelines and evidence-based therapy), preventative measures (if any), and additional information that would be important to the geriatric population with regard to fever of unknown origin. Support your answer with two or three peer-reviewed resources.

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