CASE 36
A 41-year-old white man was brought to the emergency department with a 3-day history of shaking chills, high fever, headache, abdominal pain, and generalized weakness. Mild diarrhea had started 2 days earlier and had been improving when the fever began.
PHYSICAL EXAMINATION
PE: On examination, the patient appeared ill and confused. His abdomen was diffusely tender, and his liver and spleen were enlarged, although there was no evident jaundice. Erythematous maculopapular lesions (“rose spots”) were noted on his chest (Fig. 36-1).
LABORATORY STUDIES
Diagnostic Work-Up
Table 36-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of sepsis was considered. Investigational approach may include
TABLE 36-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Typhoid (enteric) fever
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