Fever, headache, belly pain

Fever, headache, belly pain HPI     37 yo Somali male was in his usual state of health until 9 days ago he developed fever, HA and body ache...
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Fever, headache, belly pain

HPI 







37 yo Somali male was in his usual state of health until 9 days ago he developed fever, HA and body aches Fever: not measured, some relief with Tylenol but returns intermittently throughout the day/night Headache: bilateral and constant, worse in temporal regions, no visual changes, having vivid dreams, has a sore neck but not stiff, good ROM. Abdominal pain- gassy bloating, poorly localized, 6/10. Worse with meals, unclear alleviating factors. Stooling with normal color, frequency, and consistency. No nausea or vomiting, eating normally up to today(now anorexic).

HPI 









Two days later at work, he became weak and fell. No trauma from fall - told to go home. Since then he has been resting at home. Sought medical attention at local ER 2 days ago - says no tests were done and he was sent home with Tylenol. Symptoms acutely worsened last night and developed a bloody nose, dark urine (like coffee, “yellow eyes” per his sister. Similar to what he had about 1.5 yrs ago while in Uganda- was diagnosed with malaria and given shots. Remained in Uganda 4-5 months after treatment, but says when he arrived in USA Jan 2006 he was tested negative for malaria. Other Questions?

Past Medical History  Malaria

– “several times in Somalia”, “always goes away with medicine”  Immigrant screening: – RPR neg 9/06/05 – HIV ELISA neg 9/06/05 – ppD + to 19 mm, negative CXR, prescribed INH. He only took ~3 months of INH  No

medications or allergies

Social & Family history    

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Arrived in Virginia in January 2006 from Somalia via Uganda – never left MN since Moved to MN March 2006 – never left since Works in a Turkey packing plant with raw meats, in Fairbault. He lives in apartment with friends. His mother and sister live in Mpls, other siblings in the US, no children, not married. Smokes tobacco cigarettes - half ppd. Denies alcohol or other drug use ever. FHX: noncontrib, except malaria while in africa

Physical exam          

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General Appearance: NAD, thin. BP 109/64 | Pulse 101 | Temp 102.6 | Resp 20 | Ht 5' 6" (1.68m) | Wt 137 lbs 2.0 oz (62.2kg) | SaO2 100% Body Mass Index is 22.14 kg/(m^2). HEENT: Normal- Head shows no signs of trauma or recent fall -Eyes: Normal- EOMI, scleral icterus. Pupils equal and reactive to light. -Nose: Normal- free of discharge. -Mouth: Normal- No lesions present, throat is free of erythema, no tonsillar enlargement. Fair dentition. Mucous membranes dry. -Ears: Normal- Hearing grossly intact. -Neck: Normal- No thyromegaly, no stiffness. Normal neck girth. CARDIOVASCULAR: Normal- Regular rate and rhythm, normal S1/S2, no murmurs, rubs or extra heart sounds. Pedal pulses intact, no JVD, no edema, no carotid bruit LUNG: Normal- Lungs show no wheezes, crackles or course lung sounds. Chest excursion normal ABDOMEN: Normal- BS present. No organomegaly. Tender in RUQ and epigastric area, no rebound or guarding. No abdominal scars. MUSCULOSKELETAL: Normal- No joint erythema, edema, or tenderness. Muscles are nontender to palpation. Normal ROM. LYMPHATIC/VASCULAR: Normal- No cervical, supraclavicular or axillary LAD. SKIN: Normal- No rashes or lesions present, no bruising. NEURO: Normal- Cranial nerves intact. Patellar and biceps reflexes intact. Finger grip, triceps and biceps strength 5/5 bilaterally.

Physical exam          

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General Appearance: NAD, thin. BP 109/64 | Pulse 101 | Temp 102.6 | Resp 20 | Ht 5' 6" (1.68m) | Wt 137 lbs 2.0 oz (62.2kg) | SaO2 100% on RA Body Mass Index is 22.14 kg/(m^2). HEENT: Normal- Head shows no signs of trauma or recent fall -Eyes: Normal- EOMI, scleral icterus. Pupils equal and reactive to light. -Nose: Normal- free of discharge. -Mouth: Normal- No lesions present, throat is free of erythema, no tonsillar enlargement. Fair dentition. Mucous membranes dry. -Ears: Normal- Hearing grossly intact. -Neck: Normal- No thyromegaly, no stiffness. Normal neck girth. CARDIOVASCULAR: Normal- Regular rate and rhythm, normal S1/S2, no murmurs, rubs or extra heart sounds. Pedal pulses intact, no JVD, no edema, no carotid bruit LUNG: Normal- Lungs show no wheezes, crackles or course lung sounds. Chest excursion normal ABDOMEN: Normal- BS present. No organomegaly. Tender in RUQ and epigastric area, no rebound or guarding. No abdominal scars. MUSCULOSKELETAL: Normal- No joint erythema, edema, or tenderness. Muscles are nontender to palpation. Normal ROM. LYMPHATIC/VASCULAR: Normal- No cervical, supraclavicular or axillary LAD. SKIN: Normal- No rashes or lesions present, no bruising. NEURO: Normal- Cranial nerves intact. Patellar and biceps reflexes intact. Finger grip, triceps and biceps strength 5/5 bilaterally.

Laboratory Data 135

107

11

70 4.0

24

0.8

INR 1.2

ALT 62 (10-40)

Alb 2.8

Alk Phos 149 (34-104)

Ca 7.7

MCV 87

12.9 3.9

AST 65 (10-42)

17

MCH 29.7 MCHC 34.2

37.7

RDW 14.1

Differential: 56% N

0% Eos

15% L

22% Bands

6% M

1% Myelocytes

Total bili 5.9 (