CASE 65
A 31-year-old white man was brought in to the emergency department (ED) of a general hospital with the complaints of fever and visual hallucinations.
PHYSICAL EXAMINATION
LABORATORY STUDIES
Diagnostic Work-Up
Table 65-1 lists the likely causes of illness (differential diagnosis). A definitive history of an animal bite could not be established for this patient. Investigational approach may include:
Rationale: Altered consciousness is the sine qua non of encephalitis in the setting of other signs of infection, such as fever, headache, and neurologic signs. Some degree of weakness would be expected with Guillain-Barré or polio. However, the findings of agitation and hydrophobia are specific for rabies encephalitis. If these are not present, it is difficult to distinguish the various causes listed above.