Case history
A 24-year-old male, with no history of recent out of state travel,
presented to the emergency department on with the chief complaints of
fever with chills for 3 days, vomiting (3 episodes with nausea but not
blood-stained), diarrhea, dull aching abdominal pain, body ache, and
burning urination for 2 days. He reported no chest pain or
breathlessness. There were no past complaints and family history was not
significant. The patient denied any addictions and followed a vegetarian
diet.
On examination, the patient’s general condition was stable and
maculopapular rash was noted on his torso. His pulse was 82 beats per
minute, respiratory rate was 18/min, oxygen saturation was 98% on
ambient air, and temperature was 102°F. a blanching rash was noted on
the torso. On review of systems a dry cough was observed along with mild
weakness (4/5) was noted on the right side. The remainder of the
physical exam was normal.
The patient brought with him previous investigation reports from 2 days
prior showing a hemoglobin of 15.6 g/dL, white blood cell count of 8300
/µL, and platelets of 300,000 /µL. He verbally reported outside testes
for Dengue IgM and NS1, and Leptospira were negative, but could not
provide any documentation. ELISA for COVID-19 was negative in the
emergency room.
The differential diagnosis at this time included enteric fever,
influenza-like illness (ILI), urinary tract infection (UTI), legionella,
and malaria.
Investigations ordered included hemogram with differential count, urine
routine examination, electrocardiogram, chest X-ray, blood sugar
(fasting, postprandial, random), abdominal ultrasound, blood
urea/creatinine, electrolytes, cardiac markers, skin biopsy, urine
analysis along with blood urine and stool cultures.
The patient was advised hospital admission and treated with intravenous
(IV) fluids for rehydration, injection pantoprazole 40 mg once daily,
injection ondansetron 4 mg three times daily, injection paracetamol 500
mg three times daily, and, empirically, with intravenous injections of
ceftriaxone.