Case Presentation and Clinical Examination

A 45‐year‐old male farmer, non‐diabetic and non‐smoker, was referred with unintentional weight loss and malaise. On initial query, he did not volunteer focal biliary symptoms, but he reported a history of irregular fever over the preceding two months. On admission, he was febrile at 37.8°C (100°F), while the remaining vital signs were stable. The patient was not icteric, had no organomegaly, and had no lymphadenopathy.

Before referral, he had been treated empirically for presumed enteric fever and later put on prednisolone 1 mg/kg/day without a steroid‐sparing agent for suspected adult‐onset Still's disease. The fever transiently subsided, but he again became febrile within 02 weeks, so prednisolone was discontinued. His overall condition and weight loss did not improve.