What Is This International Traveler's Diagnosis?

​BY GREGORY TAYLOR, DO; DAWN ZELENKA-JOSHOWITZ, DO; & ANDREW TAECKER, DOA 34-year-old man presented with intermittent fever and body aches for 10 days. He had been visiting family in India, and the symptoms began when he returned home. His fever had been as high as 104°F, and he was experiencing nausea, two episodes of bilious emesis, body aches, nonspecific abdominal pain, and multiple episodes of watery, nonbloody diarrhea.He said he knew of no tuberculosis exposure or ill contacts, and he was current on his routine influenza and hepatitis A vaccines. His temperature was 101.4°F (he had taken acetaminophen three hours earlier), blood pressure was 98/52 mm Hg, heart rate was 125 bpm, respiratory rate was 21 bpm, and oxygen saturation was 100% on room air. The patient appeared pale and ill but in no acute distress. His oral mucosa were dry, and he was tachycardic.His lungs were clear, and his abdomen was soft and nonperitoneal with tenderness to palpation in the epigastric region and right upper quadrant. Evidence for meningeal signs was negative, and we suspected sepsis given his clinical presentation. Fluid resuscitation was initiated with 30 cc/kg, and blood cultures, a malaria screen, a peripheral smear, parasites, and stool culture were performed. He was empirically started on 2 gm ceftriaxone IV daily for suspected typhoid, deferring malaria treatment until confirmed.The patient had a leukopenia of 2.6, RBC count of 3.71, hemoglobin of 12.7 d/dL, a mean corpuscu...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research