A Man With Fever, Fatigue, and a Trip to Nigeria

Dean M. Sayre, MD, MS


March 04, 2021

Editorial Collaboration

Medscape &

A 36-year-old African man who immigrated to the United States 10 years ago presents to the emergency department (ED) complaining of fever, fatigue, headache, muscle aches, and occasional nausea and vomiting for the past 5 days. He reports no chronic medical conditions or recent illnesses but did return from visiting his parents in Nigeria roughly 1 week before the onset of symptoms. He reports receiving no vaccinations before traveling and did not take chemoprophylaxis for malaria because he grew up in Nigeria and believes he is immune.

Two days before coming to the ED, he visited an urgent care clinic with similar complaints. Blood cultures drawn at that time are negative to date and a rapid diagnostic test (RDT) for malaria was negative. Molecular assays for typhoid fever and serologic assays for dengue fever, hepatitis A, and HIV are pending.

On examination, the patient is febrile to 101.0 °F, is diaphoretic, and has diffuse abdominal tenderness to palpation. All other findings are unremarkable. Results of a complete blood count and metabolic panel are as follows:

  • Hemoglobin: 10.8 g/dL

  • Hematocrit: 32.0%

  • White blood cell count: 5.5 x 103/µL

  • Platelets: 71 x 103/µL

  • Sodium: 141 mmol/L

  • Potassium: 3.7 mmol/L

  • Chloride: 110 mmol/L

  • Glucose: 68 mg/dL

  • Creatinine: 1.6 mg/dL

  • CO2: 21 mmol/L

  • BUN: 17 mg/dL