History of Present Illness:
A man in his late 20s is brought to the ED for confusion and fever. Per medics, his roommates say he has been feeling weak for about 5 days with fever and body aches but today was not acting appropriately. The patient admits to a mild headache but denies other symptoms, specifically no chest pain, cough 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. There are no focal neurologic findings and the jolt sign is negative
Initial Diagnostic Testing:
- EKG: none
- Labs: tox all negative. WBC 7.1 but 85% PMN’s
- Imaging: a CT scan is done
What is the most likely diagnosis?
- A) Abscesses
- B) Bleeds
- C) CVAs, embolic
- D) Drug OD
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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What is the most likely diagnosis?
- A) Abscesses – CORRECT – The image shows multiple hypodense intracranial lesions, c/w small abscesses. Further evaluation with enhanced MRI was recommended.
- B) Bleeds
- C) CVAs
- D) Drug OD
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
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CASE CONCLUSION: Blood cultures grew out S. aureus in 2/2 bottles at 12 hours