To the Editor. —We read with interest the article on nosocomial febrile illnesses by Filice and colleagues1 in the February 1989 issue of the Archives. Fever in the hospitalized patient with a chronic illness indeed represents a diagnostic challenge. We recently encountered an unusual cause of temperature elevation that should not be overlooked in hospitalized patients with chronic debilitating illnesses.
Report of a Case.—A 35-year-old man with severe systemic lupus erythematosus, transverse myelitis with paraplegia, and extensive decubital ulcers was admitted to our service because of high fever and hypotension. Blood cultures yielded methicillin-resistant Staphylococcus aureus organisms, and intravenous vancomycin therapy was instituted. The patient's condition promptly improved and his vital signs became normal. He was placed on a water bed for better care of the decubital ulcers.
On the seventh hospital day, the resident on call was notified that the patient's temperature was 38°C. Blood was again