Case history
Case history #1
A 34-year-old otherwise healthy white man is seen in the emergency department. He reports 2 days of fever of up to 39.5°C (103°F), severe myalgias in his legs and back, headache, nausea, and vomiting. He lives in a trailer in a rural area of southwest Colorado and frequently sees mice in and around the trailer. He is a carpenter and has been renovating the interiors of some old barns into luxury homes. On examination he is noted to have a fever of 39°C (102°F), blood pressure of 110/76 mmHg, a pulse rate of 96 bpm, a respiratory rate of 24 breaths per minute, and oxygen saturation on room air of 96%. The remainder of his PE is normal.
Case history #2
A 54-year-old previously healthy white man from rural New Mexico was admitted to hospital 36 hours earlier for management of a presumed viral pneumonia. He was empirically begun on an intravenous fluoroquinolone and gentamicin, and oral oseltamivir pending laboratory results. On examination he seems more unwell, his blood pressure is 95/60 mmHg, pulse rate is 96 bpm, and respiratory rate is 36 breaths per minute. His oxygen saturation on 4 L/minute nasal oxygen is 90%. He has bilateral diffuse rales on lung examination and a S3 sound on cardiac examination with no murmurs.
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