The wildfire fighter with arthritis and fatigue. ID Case Conference Wednesday July 25 th , 2007 David P. Fitzgerald, MD. HPI.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
ID Case Conference
Wednesday July 25th, 2007
David P. Fitzgerald, MD
Pencillin – rash and hives
Sulfa – rash and hives
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.Physical exam
November 2006 98%
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)Data
Virologic, immunologic & clinical course following B19 infection.
Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, 6th ed.
Full text available via the UNC-CH Libraries