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 103°F (39.5°C), 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 recently been renovating the interiors of some old barns into luxury homes. On exam he is noted to have a fever of 102°F (39°C), 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 physical exam is normal.
Case history #2
A 54-year-old previously healthy white man from rural New Mexico was admitted to the 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 exam today 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 exam and a S3 sound on cardiac exam with no murmurs.
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