The wildfire fighter with arthritis and fatigue. ID Case Conference Wednesday July 25 th , 2007 David P. Fitzgerald, MD. HPI.
The wildfire fighter with arthritis and fatigue
ID Case Conference
Wednesday July 25th, 2007
David P. Fitzgerald, MD
Pencillin – rash and hives
Sulfa – rash and hives
T 36.3, pulse of 68, and blood pressure of 106/66 RR 16 Sat 98%
HEENT: Pupils are equal, round, reactive to light and accommodation. Extraocular movements are intact. Sclerae are anicteric. Oropharynx is clear without any lesions or thrush.
NECK: Supple. There is no anterior cervical, posterior cervical or supraclavicular lymphadenopathy. There is no axillary or inguinal lymphadenopathy noted.
HEART: Regular rate and rhythm. No murmurs, rubs, or gallops.
LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Soft, nontender, nondistended, no hepatosplenomegaly.
EXTREMITIES: No clubbing, cyanosis or edema.
SKIN: Nails, the patient has on her left thumb area at the distal portion of her thumbnail, which appears to be lifted off of the base and has some brown discoloration.
NEUROLOGIC: The patient is alert and oriented x3 with nonfocal neuro exam. Cranial nerves II through XII are grossly intact.
Basic panel and LFTs wnl
RMSF serologies “negative”
Lyme IgM and IGG negative
RMSF serology ”negative”
Basic panel and LFTS WNL
WBC 5.2 HGB 13.6 Plt 196
EBV serologies c/w prior infxn
CMV IGG and IGM – neg
RMSF IFA 1:160 (nml<1:20)
RMSF LA <1:16 (nml <1:16)
EHRLICHIA IGG 1:64 (nml<1:64)
Ehrlichia IGM<1:20 (nml<1:20)
Virologic, immunologic & clinical course following B19 infection.
Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, 6th ed.
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