The patient is a 30-year old woman from Charleston, South Carolina.

The patient is a 30-year old woman from Charleston, South Carolina. She was admitted to the clinic for a sore throat and vomiting that she attributes to a medication she was recently prescribed following a laparoscopic hernia operation. The patient is an equestrian who earns her living teaching riding and performing at a local renaissance fair. She is in a monogamous relationship (3 years), and is sexually active (she uses oral contraceptives and condoms). She smokes cigarettes (roughly half a pack/day), but does not drink alcohol very often and denies any drug use. She keeps a dog and a cat at her home, and routinely cares for five horses and a goat at the stable she works at. She is allergic to shellfish, and has a family history of schizophrenia (father’s side). Five months ago, she traveled to South Africa, where she spent eight days at Kruger National Park. One week ago, she underwent a laparoscopic operation for a hernia, and was prescribed a liquid laxative to prevent straining and/or constipation during her recovery. Since she began taking the laxative, she has developed a worsening sore throat, and within the last few days has been vomiting following ingestion of the medicine. She reports feeling “weak” with a headache, and has not been able to keep down many foods or liquids. Initial examination shows that the patient is dehydrated and appears to be nervous. When questioned about her emotional state, she responds that she has been under a lot of stress recently and has not been sleeping well for the past week. You administer intravenous fluids to treat her dehydration, and switch her laxative prescription. You discharge your patient; however, you ask her to come back in for a check-up in two days.

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The next day she calls you in a state of high alarm. Her right arm has been getting more and more painful and she insists that she is having a heart attack. You ask her to come in immediately.

Differential Diagnoses

Differential diagnosis is the process of identifying a disease from a list of possible diseases that fit the information derived from examining a patient. Your job will be to synthesize information from a patient whose main presenting symptoms are consistent with a microbial disease of the central nervous system (CNS). Use the “Diseases in Focus Chapter 22 tables” and your knowledge about microbial diseases of the CNS to identify the patient’s risk factors and symptoms, evaluate diagnostic evidence, formulate and test a diagnosis about the pathogen responsible for the patient’s woes, and suggest a course of treatment.

Part A – Identify relevant information.

Review the patient’s medical history, and then identify risks and concerns that are relevant to your diagnosis (and the patient’s treatment).

Indicate “YES” with a red checkmark, and “NO” with a blue checkmark.