Rickettsia rickettsii spotted fever group Ab IgG Laboratory Test Results From a 26-Year-Old Man After 1 Week of Fever, Headache, and Myalgia Based on the findings of the history and physical examination, laboratory tests were performed, the results of which are summarized in the accompanying Table. ![]() Physical examination findings showed a patient in obvious discomfort but were otherwise unremarkable, with no rash present anywhere on his body. The PCP asked repeatedly whether the patient had noticed any cuts, abrasions, or other skin abnormalities on his hands or elsewhere, but the patient insisted that there had been none. The patient had worn boots, long pants, a long-sleeved shirt, and a hat while hunting however, he had not used any insecticide spray, nor had he worn gloves while field-dressing the deer. Despite that, neither hunter found any ticks or noticed any tick bites upon their return from hunting. He recalled noticing that the deer had evidently been in the swamp for some time, because it was covered in ticks. His father had shot a deer, and the patient had helped field-dress the deer (ie, remove the internal organs). Noting that the patient’s father had been experiencing the same symptoms, the PCP pressed further about where the two had been together the patient stated that they had been hunting in a swamp in Tennessee. The patient reviewed physical activities, sexual contacts, food consumption, and locations visited. Because the patient had only returned from a trip to Tennessee 6 days previously, the PCP began looking for information that would be useful in determining the etiology of the man’s symptoms in relation to his recent activity while on vacation. The patient’s symptoms did not improve, so he presented to his PCP’s office, 5 days after onset of symptoms. He was told not to return to the urgent care clinic, given that the clinical workup had not revealed any serious illness, but instead to follow up with his PCP in 48 hours if symptoms persisted. The patient was again diagnosed with “a flulike illness” and was given ibuprofen and ondansetron. Complete blood cell count results showed leukopenia (white blood cell count, 2390/µL), and urinalysis revealed elevated levels of WBCs (11/high-power field), red blood cells (5/high-power field), hyaline casts (8/low-power field), protein (100 mg/dL), ketones (10 mg/dL), hemoglobin (1+), and urobilinogen (>12 mg/dL). The results of a comprehensive metabolic panel showed an elevated alanine aminotransferase (ALT) level of 67 U/L, an elevated aspartate aminotransferase (AST) level of 80 U/L, an elevated creatinine level of 1.4 mg/dL, and thrombocytopenia (platelet count, 125 × 10 3/µL). The patient’s fever and fatigue did not abate, and his myalgia and nausea continued to worsen 48 hours after his initial visit to the urgent care clinic, he returned to the same clinic for imaging and additional laboratory testing.Ĭhest radiography findings were unremarkable, and test results for influenza A and B viruses, streptococcus, and Epstein-Barr virus were negative. ![]() He returned home and decided to stay home from work for a few days to rest. He was diagnosed with “a flulike illness” and was given acetaminophen. He became extremely fatigued and experienced abnormally intense myalgia, prompting him to have a friend take him to an urgent care clinic late in the evening.Īt the urgent care clinic, test results for influenza and streptococcal infection were both negative. As the day progressed, however, the patient’s fever continued to rise. The patient learned that his father back in Tennessee simultaneously had been experiencing the same symptoms both men assumed that they had been exposed to the same sick contact and had contracted influenza, since neither had received a recent flu shot. The patient explained to the PCP that a week ago, he had been healthy and had traveled to Tennessee to visit family and to hunt 2 days after having returned to the Pensacola area, he had awoken with a fever and myalgia and had decided to stay home from work. He was worried because he had already been to an urgent care clinic twice within a week with the same concern, and his symptoms appeared to be worsening. ![]() A 26-year-old man presented to his primary care physician (PCP) in Pensacola, Florida, with fever, headache, and myalgia.
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