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A 37-year-old man with bipolar disorder and active polysubstance abuse presented with 4 days of fever, chills, drenching sweats, and generalized fatigue. He reported daily inhalational use of both heroin and cocaine and also had a dental extraction in recent weeks. Vital signs were significant for a fever of 41.67°C (101.7°F). Active rigors were noted on initial assessment. Examination of the mouth revealed no evidence of active dental infection, cardiac examination was without murmur, and no cutaneous stigmata of infective endocarditis or active intravenous drug use were present. Laboratory testing was unremarkable. Electrocardiogram was normal.
The American Journal of Medicine

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