Infectious Disease
Case 20: A Farmer with Night Sweats and a Large Spleen
CASE
A 62‐year‐old cattle farmer was admitted to your hospital with a 3‐week history of malaise, muscle ache and night sweats. He had unintentionally lost 3 kg in weight over this period. On examination he was febrile, with a heart rate of 105 beats/min and an arterial blood pressure of 120/80 mmHg. He had cervical lymphadenopathy and a palpable splenic tip. He had right sacroiliac tenderness but this did not hinder his range of movement. Examination of his chest and central nervous system was normal. He had a tender macular lesion about 4 × 3 cm on both shins. He had an ECG which showed a sinus tachycardia and his chest radiograph was clear.
The following results are available:
Hb 10.5 g/dL WCC 2 × 109/L(75% neutrophils) Platelets 220 × 109/L CRP 190 mg/L ESR 40 mm/h U&Es Normal LFTs Normal Calcium Normal
QUESTION 1
Your score this session: 0 of 0
What is the likely pathogen causing this disease process?