Clinical Case:  Management of Infectious Disease, Differential Diagnosis

 

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  •  Medical Setting: A 28 year-old male IV drug abuser, having recently received his unemployment check, seeks medical attention at the University emergency department.

  •  Chief Complaint/History:

    • Fever for the last six hours

    • Perfused sweating & palpitations

    • Last used IV heroin about a day before coming to the emergency department
       

  • Physical Exam:

    • Unkempt male with multiple tattoos, perspiring profusely.

    • Temperature: 40

    • BP: 100/50 mm Hg

    • Pulse: 120

    • Fundi- without lesions

    • Pharynx-normal

    • Lungs-clear

    • Cardiovascular-3/6 systolic murmur at the apex radiating to the base and extremities; a right-sided 2/6 diastolic rumble.

    • Fingernails-no splinter hemorrhages




       

The differential diagnosis could include (1) (acute, right-sided, with septic emboli to the lungs), (2) , or (3) fever. If this is an infectious disease, the three most likely pathogens would be (1) , (2) , (3) .