A 17-year-old female was diagnosed with inflammatory bowel disease and started on infliximab. A few weeks after starting infliximab, she developed a recurrence of daily fevers associated with an intermittent dry cough, which worsened over the course of a month. A chest radiograph, abdominal ultrasound, and computed tomography scan of the chest and abdomen revealed a heterogeneous spleen with multiple hyperechoic areas, tiny splenic micronodules, and diffuse micronodularity throughout the lungs. She was transferred to a tertiary care hospital because of hypotension, new oxygen requirements, and ongoing fever. Her bloodwork on presentation to tertiary care revealed pancytopenia and elevated inflammatory markers; she had splenomegaly on MRI. As her clinical picture evolved, she continued to have persistent fevers and anorexia despite ongoing management. Infectious diseases, rheumatology, and gastroenterology were consulted to guide the evaluation and management of this patient's complex clinical course.

中文翻译：

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青少年溃疡性结肠炎治疗后长时间发烧。


一名 17 岁女性被诊断患有炎症性肠病，并开始服用英夫利昔单抗。开始使用英夫利昔单抗几周后，她每天发热复发，伴有间歇性干咳，并在一个月内恶化。胸部和腹部的胸片、腹部超声和计算机体层成像扫描显示脾脏异质性，具有多个高回声区域、微小的脾微结节和整个肺部的弥漫性微结节。由于低血压、新的氧气需求和持续发热，她被转移到一家三级医院。她在接受三级保健时进行的血液检查显示全血细胞减少和炎症标志物升高;她在 MRI 上有脾肿大。随着临床表现的发展，尽管进行了持续治疗，但她仍持续发热和厌食。咨询传染病、风湿病学和胃肠病学，以指导对该患者复杂临床病程的评估和管理。