A 33-Year-Old Man With Shortness of Breath, Leukocytosis, and Intermittent Fevers

A 33-year-old man with ulcerative colitis (UC) and primary sclerosing cholangitis presented with worsening shortness of breath, nonproductive cough, and intermittent fevers after he was found to have a WBC count of 27,000 cells/μL on an outpatient laboratory evaluation. He reported feeling progressively unwell with intermittent right upper quadrant pain and shortness of breath since a hospital admission for a UC flare 6 months prior, during which he was first diagnosed with primary sclerosing cholangitis. He noted that prior to that admission 6 months ago, his UC had been in remission for > 10 years. He reported fevers up to 38.9°C on and off for several weeks but was afebrile (37.2°C) on presentation. He endorsed non-bloody diarrhea, chills, night sweats, leg swelling, and associated leg pain. He had a cough but denied sputum production. He reported no recent travels and denied sick contacts. His medications included mesalamine, ursodiol, montelukast, and an albuterol inhaler.