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QUESTION 9

A 27-year-old woman returned 5 days ago from Venezeula, where she had been touring rural sites on the coast and inland for bird watching and white water rafting.

She complains of two days of fever to 102°F, headache, and diffuse myalgias that are most prominent in her neck. She has a faint macular rash over her trunk and limbs. There is no lymphadenopathy.

She received a full range of immunizations prior to travel and has been taking doxycycline daily (without missing doses) for malaria prophylaxis.

The most likely cause of this syndrome is:


(1) Plasmodium vivax

(2) Leptospirosis

(3) Dengue

(4) Toxoplasmosis

(5) Scrub typhus (Orientia tsutsugamuchi)

Labs:

WBC 3.8 Platelets 137,000 Hg 12.3 g/dl

Bilirubin, Alkaline phosphatase, ALT and AST normal

Chest X-ray: normal

Malaria smear: pending

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BOF 22 Jan 2016

By Wong Chen Seong