Clinical Presentation
A 27-year-old, white man presents with altered mental status and agitation.
History and Physical Examination
History. The patient's illness started with a nonspecific fever to 102o F that was accompanied by a mild headache and myalgias. He felt ill enough to stay home from work but not ill enough to seek healthcare, crediting the fever to "what was going around" that August. He improved and his fever resolved the week before admission in early September, when he became agitated, violent, and confused. He was brought to the emergency room and required 4-point restraints and sedation, followed by intubation. He had no new symptoms in the day preceding the onset of agitation.
History revealed the following:
Medical history: none
Medications: none
Allergies: none
Habits: drinks on weekends
Diet: regular
Travel: recent hiking trip to Eastern Oregon and the Cascades; he had returned to Portland 48 hours before the fevers started
Social: single, recently moved in with his girlfriend
Pets: 2 cats, belonging to his girlfriend
Immunizations: up to date
Sports/water exposure: drank stream water, swam in lakes while hiking; numerous mosquito bites
Infectious disease exposure: none known
Physical examination. On physician examination, the following were noted:
Vital signs: temperature: afebrile; pulse: 90 beats/min; respirations: 18 ventilator breaths/min; blood pressure: 118/78 mm Hg
General: not chronically ill
HEENT: scattered 1-2 cm lymph nodes, neck supple, endotracheal tube in place
Lungs: clear
Heart: normal, no murmurs, rubs, gallops
Abdomen: nontender; spleen tip possibly palpable
Extremities: normal
Skin: no rashes
Genitourinary: normal
Neurologic: moves extremities to pain only; not requiring sedation on ventilator, does not respond to voice
Diagnostic Evaluation
Lab results. The following results were obtained:
WBC: 5.8 x 103/mm3
Hgb: 14 g/dL
Differential: 68% polymorphonucleocytes; 22% lymphocytes
Basic metabolic panel: normal
Bilirubin: 0.9 mg/dL
Transaminases: normal
Urinalysis: normal
Drug screen: normal
Lumbar puncture
WBC: 30 x 103/mm3 with 69% lymphocytes, 28% monocytes, and 3 polymorphonucleocytes
Protein: 101 g/dL
Glucose: 86 mg/dL
Imaging
Chest radiograph: normal
CT: normal
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Cite this: A Young Man With Fever and Confusion - Medscape - Feb 10, 2012.
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