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A 52-year-old female presented with the chief complaints of fever for 2 months, vomiting for 1 month, reduced urinary output for 1 month, and altered sensorium for 1 week.

She had been asymptomatic 2 months back, when she developed a low-grade fever (98-99 [degrees] F) with a maximum of 102 [degrees] F. There were no localizing symptoms. She had been treated elsewhere for typhoid (Widal test was negative) but the fever persisted. Based on chest X-ray findings, she was started on antitubercular drugs in November 2004. There was history of vomiting for the last 1 month, which was nonprojectile and nonbilious. There was no associated diarrhea, hemetemesis, melena, or abdominal pain. There was history of loss of appetite and decreased urinary output (~ 150-300 ml/day) for the last month. There was no history of dysuria or hematuria. The patient was given hemodialysis at another hospital (4 times) and 7 …