Can I use this site to request help with a differential for an I.D. problem? If so, here is the presentation: 18 year old black female with 3-4 days of fever 102-103, myalgias arms and legs, headache wihout meningismus, although h/a with motion of head and her eyes; NO rash, menses occuring, in the carribean one week earlier with an overnight with family in Jamaica, NO hx tic bite; maybe one or two mosquitoe bites, sweats and chills at night 1-2 nights. No real cough of any signicance. Mom with history of colitis (?u.c.), and lupus. PExam notable: not toxic, although ill with malaise. Moderate upper lid edema without erythema or tenderness. No other visible edema. Small residual induration without pain or erythema at upper gluteal cleft. She is on the last day of Bactrim for treatment of a pilonidal cust infection. It looks good and appears to be a red herring. Lab: WBC 2.5 (leukopenia), nl diff, nl h/h; u/a +3 blood but MENSES; neg protein. CRP, Sed RAte, Blood culture, CMP pending. Your thoughts???? Thanks, Marc Tanenbaum, MD Atlanta, GA
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Since she has fevr, leukopenia with history of mosquito bites, rule out dengue and malaria(if it is common in Jamaica). Further thoughts can be only after CBC report (Hb, platelets and whether leukopenia is improving or not)
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