A Traveler's Fever

Roberta Capp, MD; Natan Noviski, MD


December 11, 2017

Physical Examination and Work-up

Upon physical examination, the patient's temperature is 103.0°F, pulse is 83 beats/min, blood pressure is 120/70 mm Hg, respiratory rate is 16 breaths/min, and oxygen saturation is 96% while breathing room air. The patient is generally well-appearing, alert, and oriented. Examination of the head, eyes, and pupils is unremarkable. The neck is supple, without any lymphadenopathy.

During auscultation, the lungs are clear; the patient's heart has a regular rate and rhythm, without any murmurs. Examination of the abdomen reveals normal bowel sounds, with mild tenderness to palpation in the right and left upper quadrants. The spleen is noted to be 3 cm below the costal margin. Neurologic examination is unremarkable.

The patient is treated with intravenous fluids. ECG shows a normal sinus rhythm, with a corrected QT interval (QTc) of 390 msec. Serum laboratory tests are done and are significant for the following values:

  • Creatinine: 1.2 mg/dL;

  • Magnesium: 1.2 mg/dL;

  • Alanine aminotransferase (ALT): 110 U/L (normal range, 0-35 U/L);

  • Aspartate aminotransferase (AST): 159 U/L (normal range, 0-35 U/L);

  • Total bilirubin: 2.7 mg/dL (normal range, <1.20 mg/dL);

  • Direct bilirubin: 0.9 mg/dL (15.39 μmol/L) (normal range, <0.20 mg/dL); and

  • Alkaline phosphatase, 152 U/L (normal range, 30-130 U/L).

A complete blood count reveals a white blood cell count of 5.7 × 103 cells/µL, a hematocrit of 44% (0.44), and platelet count of 34 × 103 cells/µL. A blood smear is obtained (Figure 1).

Figure 1.


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