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.