Altered Young Adult
UnFiNiShEd CaSe CoMe BaCk LaTeR
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History of Present Illness:
A man in his late 20s is brought to the ED for confusion and fever. Per medics roommates say he has been weak for about 5 days with fever and body but today was not acting appropriately. He admits to a mild headache but denies other symptoms, specifically no chest pain or SOB.
Vital Signs & Physical Exam:
Vital signs are normal except for a fever of 38.5 Physical exam is otherwise normal except for mild to moderate confusion
Initial Diagnostic Testing:
- EKG: none
- Labs: tox all negative. WBC 7.1 but 85% PMN’s
- Imaging: a CT scan is done
QUESTIONS:
- What does the case image show?
- What should you do next?
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- Want to know what happened with this patient?
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ANSWERS:
- What does the case image show? The image shows multiple hypodense intracranial lesions. Further evaluation with dedicated enhanced MRI was recommended.
- What should you do next? Treat with IV antibiotics, admit, consult ID
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- Want to know what happened with this patient? See case conclusion below tutorial page.
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CASE CONCLUSION: Blood cultures grew out S. aureus in 2/2 bottles at 12 hours