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Previous Volume 348:2239-2247 May 29, 2003 Number 22 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Presentation of Case

A 38-year-old woman was admitted to the hospital in early August 2002 because of fever and confusion.

The patient had been well until four days earlier, when a headache gradually developed and increased in intensity, accompanied by mild photophobia and stiffness of the neck. Two days before admission, she believed that she was mildly febrile. The day before admission, she was examined at another facility, where she was told she had a "viral illness." She was given fluids intravenously and was discharged. On the morning of admission, she awoke with shaking chills and a temperature of 40°C. During the day . . . [Full Text of this Article]

Differential Diagnosis

Eastern Equine Encephalitis Virus

St. Louis Encephalitis Virus

Powassan Virus

West Nile Virus

Clinical Diagnosis

Dr. Martin S. Hirsch's Diagnosis

Pathological Discussion

Clinical Discussion

Pathological Diagnosis

Source Information

From the Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (M.S.H.); and the State Laboratory Institute, Jamaica Plain, Mass. (B.W.).

This article has been cited by other articles:

• Hirsch, M. S., DeMaria, A. Jr., Schaefer, P. W., Branda, J. A. (2008). Case 22-2008 -- A 52-Year-Old Woman with Fever and Confusion. NEJM 359: 294-303 [Full Text]  
• Harris, N. L. (2003). Case Records of the Massachusetts General Hospital -- Continuing to Learn from the Patient. NEJM 348: 2252-2254 [Full Text]