1/ We're going to try something new. Tomorrow, we release a new episode of #Hoofbeats ๐. Today โ right here, right now โ we're giving you a preview of the case. We would love to hear your thoughts as you go through it.
2/ Once again, we've teamed up with @hdx for this episode. Be sure to submit your final prioritized differential and plan to the website where you can see the community's response as well: humandx.org
3/ A 23 y/o man presents with 3 days of confusion and flu-like symptoms: fever๐ก๏ธ, myalgia, sore throat, productive cough.
His friends say he was "off" - they can't put their finger on it - but this morning they found him collapsed on the bathroom floor and disoriented.
His friends say he was "off" - they can't put their finger on it - but this morning they found him collapsed on the bathroom floor and disoriented.
4/ He also had nausea๐คข and one episode of vomiting๐คฎ.
6 months ago, he was diagnosed with Crohn disease by lower endoscopy. He is on azathioprine and infliximab. He had no IBD symptoms when this illness began.
He is from Sheffield, England๐ด๓ ง๓ ข๓ ฅ๓ ฎ๓ ง๓ ฟ and is on vacation in NYC.
6 months ago, he was diagnosed with Crohn disease by lower endoscopy. He is on azathioprine and infliximab. He had no IBD symptoms when this illness began.
He is from Sheffield, England๐ด๓ ง๓ ข๓ ฅ๓ ฎ๓ ง๓ ฟ and is on vacation in NYC.
5/ He arrived three weeks ago. He's staying at a hotel with friends and has not left the city since he arrived. He reports "moderate" drinking๐ป๐ป๐ป in the bar scene but hasn't had a drink since he began to fall ill. He is not sexually active.
6/ We're going to take a break right here. How are you thinking about this case? What are you going to look for on physical exam?
We'll be back this evening with more.
We'll be back this evening with more.
7/ Let us continue.
VS T 104.6F | BP 130/70 | HR 128 | RR 24 | SaO2 98% RA
Gen: awake & interactive, appears very tired and ill
Resp: tachypneic w decreased breath sounds in L upper lung field
CV: tachy, otherwise nml
HEENT, neck, skin & and all nml
VS T 104.6F | BP 130/70 | HR 128 | RR 24 | SaO2 98% RA
Gen: awake & interactive, appears very tired and ill
Resp: tachypneic w decreased breath sounds in L upper lung field
CV: tachy, otherwise nml
HEENT, neck, skin & and all nml
8/ Neuro:
๐Attn: cannot perform serial 7s or repeat # backwards
๐Speech: scanning
๐Gait: unsteady, wide-based
๐Cerebellar: dysdiadochokinesis and dysmetria present bilaterally
๐CN, strength and sensation: normal
๐Attn: cannot perform serial 7s or repeat # backwards
๐Speech: scanning
๐Gait: unsteady, wide-based
๐Cerebellar: dysdiadochokinesis and dysmetria present bilaterally
๐CN, strength and sensation: normal
9/ WBC 2.6 (76%N, 20%L, 5%M)
Hgb 11, MCV81
Plt 87K
AST 357
ALT 111
AlkP 24
TBili 0.4
CXR below
NCHCT normal
Hgb 11, MCV81
Plt 87K
AST 357
ALT 111
AlkP 24
TBili 0.4
CXR below
NCHCT normal
10/ Itโs LP time!
CSF Analysis
Appearance: clear & colorless
Opening P: 19mmHg
Glu: 78
Prot: 19
Cell count: 13 (0% segs, 7% lymphs, 88% monos)
Gram stain: no organisms seen
Culture: no growth
HSV PCR: neg
CSF Analysis
Appearance: clear & colorless
Opening P: 19mmHg
Glu: 78
Prot: 19
Cell count: 13 (0% segs, 7% lymphs, 88% monos)
Gram stain: no organisms seen
Culture: no growth
HSV PCR: neg
11/ Chest CT below
And then...a diagnostic test was performed.
What are you thinking now? Give us your impression, your prioritized differential, or whatever else youโre inspired to share!
And then...a diagnostic test was performed.
What are you thinking now? Give us your impression, your prioritized differential, or whatever else youโre inspired to share!
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