INFECTIOUS DISASES PAPER CASE FOR STUDENTS

Given the following case, the 3rd year medical student should be able to:
1. Recognize infections that require emergent attention.
2. Generate differential diagnosis.
3. Formulate a rational treatment and prevention plan.

CASE

A 30 year old male from Quezon City presents at the emergency room with a 10 day history of
fever associated with myalgia, headache, tea-colored urine, and decreased oral intake. No
history of cough, dysuria, vomiting, dyspnea, and diarrhea. Vital signs showed BP of 110/70
mmHg, tachycardia at 110, RR 21, temp of 38.2. Other physical examination revealed anicteric
sclerae, pale palpebral conjunctivae, dry oral lips and mucosa, minimal right upper quadrant
abdominal tenderness. The rest of the PE is unremarkable.

1. WHAT OTHER INFORMATION WILL YOU ASK FROM THE PATIENT? See Handout 1

2. WHAT DIFFERENTIAL DIAGNOSIS WILL YOU CONSIDER?

3. WHAT DIAGNOSTIC TESTS WILL YOU REQUEST TO DETERMINE THE ETIOLOGY OF THE
FEVER?
HANDOUT 1

10 days prior to consult, fever pattern is intermittent that with no relief after Paracetamol
intake. Fever usually occurs throughout the whole day (temperature ranging from 39 to 40
degrees Celsius), associated with chills, profuse sweating, prostration, weakness, myalgia,
generalized abdominal pain, and headache (pain score of 6-7/10). The fever will lyse the
following day with improvement of associated symptoms and would recur the next day with
same characteristics. No consults and other interventions were done.

Review of Systems:
No vomiting, dizziness, diarrhea, constipation, tea-colored urine, acholic stools, joint pains
No change in sense of taste, smell, blurring of vision, dysuria

Past Medical History: unremarkable

Family History: Hypertension, father

Social History: Non-alcoholic beverage drinker, non-smoker, no history of illicit drug use.

Living Environment Condition / Occupational exposure: patient lives in a single bedroom

condominium. No indoor pets and history of animal bites from the past 3 weeks. The patient
works as a social media influencer/travel vlogger.

Other pertinent information:

- No previous antibiotic use and prophylaxis for the past 3 months
- No history of wading in flood water
- Patient is fond of eating street food
- The patient had a history of travel to Rizal town in Southern Palawan one month ago
- Activities in his travel include mountain hiking and spelunking.