Case 22-2008 -- A 52-Year-Old Woman with Fever and Confusion

doi:10.1056/NEJMcpc0804149

Volume 359:294-303		July 17, 2008		Number 3

Case 22-2008 — A 52-Year-Old Woman with Fever and Confusion

Martin S. Hirsch, M.D., Alfred DeMaria, Jr., M.D., Pamela W. Schaefer, M.D., and John A. Branda, M.D.

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

Dr. Marylyn M. Addo (Infectious Disease): A 52-year-old womanwas admitted to this hospital in late summer because of feverand confusion. The patient had been well until 9 days earlier,when she told family members that she felt unwell. During thenext 4 days, fatigue, lethargy, tenderness over the mastoid,tingling of the tongue, myalgias of the legs, and headache developed.Five days before admission, she saw her primary care physician;results of routine laboratory tests were said to be normal.Computed tomography (CT) of the mastoid was scheduled.

Two days before admission, the patient returned home from work. . . [Full Text of this Article]

Differential Diagnosis

Bacterial Infections

Viral Infections

Herpes Simplex Virus

Arboviruses

West Nile Virus

Eastern Equine Encephalitis Virus

Summary

Clinical Diagnosis

Dr. Martin S. Hirsch's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Infectious Disease Service, Department of Medicine (M.S.H.), and the Departments of Radiology (P.W.S.) and Pathology (J.A.B.), Massachusetts General Hospital; the Massachusetts Department of Public Health (A.D.); and the Departments of Medicine (M.S.H.), Ambulatory Care and Prevention (A.D.), Radiology (P.W.S.), and Pathology (J.A.B.), Harvard Medical School — all in Boston.