The Clinical Problem Solvers Episode 441 – RR w/ Shantanu Rai – Fevers and Weight Loss
Feb 1, 2026
Shantanu Rai, a primary care physician and author of the novel A Dangerous Diagnosis, presents a clinical case adapted from his book. The conversation covers a four-month fever with weight loss, dramatic labs like very high ferritin and LDH, and the diagnostic reasoning that refocused the case. He also explains why he wrote a medical thriller and the storytelling behind clinical puzzles.
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Young Marine With Months Of Fevers
- Shantanu Rai recounts a 26-year-old female Marine with daily spiking fevers for four months and extensive negative workups.
- The patient was bounced across bases and seen by many doctors before the case reached the narrator.
Inventory Fever Consequences First
- When fever is prolonged, inventory consequences (organ-specific findings) rather than chasing fever alone.
- Reframe the problem into 'inflammatory X' (e.g., inflammatory liver disease) to target diagnostics and therapy.
Get Pan-CT Early In FUO Workup
- Before labeling fever unknown, get cross-sectional imaging of chest, abdomen, and pelvis and review basic inflammatory markers.
- Use imaging early to detect structural causes (malignancy, abscess) that often explain weight loss and fever.
