The Kitchen Sink

I've been following a particular patient for a few days now who just received a formal ID consult.  This patient has a poor prognosis because his chemotherapy for his stage 4 lymphoma has to be delayed due to a persistent fever.  We've tried to identify the source over the last week, but so far nothing is growing out of the cultures and despite the standard of care antibiotics, his fever just won't stop.  We've had him on vancomycin and meropenem until today when ID decided to throw the kitchen sink at him.  Our team thought it might be a slow going fungal infection so we had already started him on some fluconazole.  I'm not sure if ID even knows what's going on because they recommended to replace the vancomycin with linezolid, keep meropenem, keep fluconazole, add metronidazole, add levofloxacin and finally the kicker - add ivermectin.  Back home I associate ivermectin more with use in dogs since worms are far less common in the US but for this particular patient, he is from Indonesia and in the tropics, you see a whole bunch of weirder things.  We'll see how he progresses but at this point it looks like it's a "your guess is as good as mine" mentality and hopefully he'll turn the corner soon.