How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?

Our hematologist/oncologist referred just such a patient. No evidence of malignancy, but elevated CRP &ESR. I did an “internist’s” workup as I would for dermatomyositis, starting with the most important and therefore most thorough aspect: taking a full and very “invasive” history, followed by a comp...

An elevated ESR and C-RP raises concern for the usual suspects: infection, malignancy, and inflammatory conditions. Generally speaking, by the time we see these patients, occult infection has likely been ruled out, leaving us to focus on the latter two groups of disorders.

Among the malignancies, I ...

I agree with my friend, mentor and colleague @Dr. First Last but would pose one question and one other consideration.

Had the oncologist already performed "pan-scans" (a term I hate almost as much as "transaminitis")--CT scans of the chest, abdomen and pelvis looking for occult lymphoma or solid tumo...

We tend to see these from the primary care providers. The hematologist/oncologist knows to check the SPEP and UPEP in these folks. After the very important thorough history and physical that Dr. @Dr. First Last advocates, I do remind patients that elevated BMI can elevate both the ESR and CRP, and t...