CASE 85
On a summer day in August, an 18-year-old man was taken to the emergency department of a local hospital because of a 2-day history of fever, weakness, pain in his left groin, and diarrhea. The groin pain was so severe that he walked with a limp, with his left leg abducted. He also had small rashes on his leg.
The patient lived in Flagstaff, Arizona. He had maintained good health before the current event.
PHYSICAL EXAMINATION
LABORATORY STUDIES
Diagnostic Work-Up
Table 85-1 lists the likely causes of illness (differential diagnosis). The patient was considered to have lymphadenitis and sepsis. Investigational approach may include
TABLE 85-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Lymphadenopathy can be caused by many infectious and noninfectious processes. A careful history will usually elicit some risk factor, such as cat exposure for cat-scratch disease, or recent sexual activity for chancroid or other STD. An abscess would be fluctuant. Except for plague, the other diseases listed generally do not produce severe systemic illness.
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