Infectious Disease Q 5

A 43-year-old man is seen in follow-up for fever up to 38.3 °C (101 °F) occurring periodically over the past 3 months. He has no associated symptoms other than fatigue. He reports no recent travel, animal exposures, or tick or insect bites. He does not eat raw meats, raw seafood, or unpasteurized dairy products. He returns for further evaluation after initial testing. Family history is negative for undiagnosed fevers. He takes no medications.

On physical examination, temperature is 37.8 °C (100.1 °F), blood pressure is 114/72 mm Hg, pulse rate is 88/min, and respiration rate is 14/min. A complete physical examination is unremarkable.

HIV testing is negative. An interferon-γ release assay for tuberculosis is negative. Three sets of blood cultures are negative.

A chest radiograph is normal.

Which of the following is the most appropriate diagnostic test to perform next?

A Bone marrow biopsy

B CT of the abdomen and pelvis

C Liver biopsy

D Lumbar puncture

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