We heard a case of a 78 year old male with no significant past medical history who was diagnosed with Alzheimer’s disease in the past 4 months (MOCA 14/30).
Important teaching points:
Elderly patients who are found down can have significant muscle weakness especially in the lower extremities that can take several days to resolve.
Elevated ESR and CRP are important in the work up of FUO or to trend when treating certain infections. Remember that most infections, including aspiration pneumonia, can cause significant elevations in ESR and CRP (bacterial infections in particular are known for CRP >15).
Many bacterial and viral infections in the elderly or immunocompromised can take several days to begin to resolve. Fevers can persist for 48 to 72h and as long as patients are hemodynamically stable waiting it out is appropriate.