ID Case Presentation HPI HPI History History
Rossi, Donna, General Assignment Reporter has reference to this Academic Journal, PHwiki organized this Journal ID Case PresentationMichael Esk in addition to er, PGY-3Dr. Lanny Hsieh8/7/2014HPICC: Flu-like symptomsHPI: 45YO Hispanic male with multiple-day history of generalized fatigue, malaise, in addition to fatigue stating he cannot even get out of bed.Then developed productive, non-bloody cough associated with rhinorrhea in addition to frontal sinus headaches.Associated with night sweats in addition to subjective fevers at homeWeight loss of unquantifiable amount as long as a few months may be due to loss of appetiteHPI+ left lateral neck pain. – HANo photo-/phonophobia, No blurry vision+ profuse, watery, nonbloody diarrhea ~3x/dayNo sick contacts, recent travel, camping/tick bites- stiffness or tenderness of medium/large jointsAlso notes a rash that began on the top of his as long as ehead in addition to appeared to have spread down his body involving his chest, then abdomen in addition to legsSignificant desquamation of his bilateral palms in addition to dorsum of feet with associated swelling in addition to tightness surrounding the digits. Believes that he received all his childhood vaccinations but has not seen a physician in addition to is unclear of whether he was able to receive booster vaccinations.
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HistoryPMHx:Incarcerated from 2006-2013: at that time he was found to be PPD positive in addition to was treated as long as latent with likely isoniazid x 6 months. Never had active TB.DM2 on insulinHTNOUTPATIENT MEDS:Met as long as min 500 mg orally 2 times a dayLantusRegular insulin correctional scaleHistoryFamily History:Dad: HTN, DM. ESRD on HDMom: HTN, DMSocial History:Etoh: history of significant binge drinking 4-5 years. currently social drinking. Quit 3 years ago. Tobacco: 1-2ppd x 20-30 years. currently smoking 1ppd. IVDU: denies. Living Status: Santa Ana with wife.Allergies:No Known Allergies PhysicalVital Signs:Tc: 37.5 HR: 100 BP: 119/60 RR: 32 SpO2: 92% on NCGen NAD. AAO x3HEENT: EOMI PERRLA anicteric sclera. Multiple tender lymph nodes in the posterior cervical chain. dry oral mucosal. no nuchal rigidity.CARD: RRR no m/r/gPULM: CTAB no w/r/cABD: Soft NT/ND positive BS.EXT: no c/c/e. 2+ distal pulses. Soft tissue swelling of the bi-lateral h in addition to s.NEURO: CN II-XII intact. no focal motor or sensory deficits.Skin:Multiple bright red punctate nonblanchable lesions overlying the lateral aspect of the bi-lateral feet.Diffuse scaly erythema overlying the entire body.Desquamation of the bilateral palms with shortened ragged nails.
LabsLactate: 1.8121 86 14—< 413 Ca: 9.25.5 26 1.2WBC: 5.6 / Hb: 17.1 / Hct: 50.1 / Plt: 168- Diff: N:4.3% L:0.4% Mo:0.9% Eo:0.0% Baso:0.0%Prot: 7.3 / Alb: 3.1 / Bili: 1.3 / AST: 63 / ALT: 164 / AlkPhos: 545UA: >1000 Glucose, +Ketones, no other abnormalitiesImagingImaging
ImagingDdxCommon cold Viral syndrome – Rhinovirus, parainfluenza, influenza, adenovirus, RSV, parvovirus B19Dengue fever (travelers)Measles (Rubeola)VZVScarlet feverRickettsial infection (campers) Drug eruptionHSP IgA vasculitisHospital CourseED: Vanc/Zosyn. IVF rehydration. HOD 1:- Vanc/Zosyn Stopped, Hyponatremia resolvedRSV, Influenza A+B: negativeSputum AFB negative x2HIV: NegativeTPA: NegativeC diff.: Negative CK, Plasma: 25 IU/LC Reactive Protein, Plasma: 7.4 MG/DLSedimentation Rate: 38 MM/HRR. rickettsii IgG: NegR. rickettsii IgM: NegR. typhi IgG: NegR. typhi IgM: NegQuant. TB Gold: NegHepatitis C IgG: Reactive A1C: 14.4Measles IgG: 2.58Measles IgM: >40 (>=20 positive)Measles PCR positive
MeaslesClassical Manifestations:Incubation, Prodrome, Exanthem, RecoveryIncubation usually 8-10 daysProdrome Fever, malaise, anorexia followed by conjunctivitis, coryza, in addition to coughKopliks spots: 1-3mm whitish, grayish, or bluish elevations with erythematous base Exanthem maculopapular, blanching rash beginning on the face in addition to spreading cephalocaudally in addition to centrifugally to involve the neck, upper trunk, lower trunk in addition to extremitiesRecovery 48hrs following exanthem. Cough may persist. Immunity occurs.MeaslesKopliks SpotsClassic Measles ExanthemThank You!
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