Old disease, new twist.

An 81-year-old man with a history of high-grade urothelial carcinoma of the bladder and ureter on treatment with atezolizumab and tiragolumab presented to the emergency department with 5 months of malaise, generalized weakness, and fatigue and 2 weeks of subjective fevers. One month prior to presentation, he received an empiric 9-day course of levofloxacin for possible epididymitis based on scrotal pain and an ultrasound showing mild bilateral epididymal prominence. Blood and urine cultures were negative. His constitutional symptoms persisted, and he developed a subjective fever 2 weeks prior to presentation. He was admitted for further evaluation.