Case history
Case history
A 40-year-old man presents with fever of abrupt onset, severe headache, malaise, nausea, and vomiting. Fever has been accompanied by chills on occasion and has not responded well to over-the-counter medicines. The patient also reports vague abdominal pain, myalgias, and arthralgias. Physical examination reveals a small round erythematous lesion on the back with a small necrotic dark centre. Noteworthy features from social history include frequent outdoor activities during the summer months including gardening and hunting.
Other presentations
Rigors may occur with fever. Uncommon presentations include cough, dyspnoea, diarrhoea, or a rash on any part of the body. Central nervous system manifestations are rare but may indicate severe disease and include stiff neck, confusion, photophobia, stupor, or seizures. Lymphadenopathy, jaundice, hepatomegaly, and splenomegaly may be seen on physical examination. Severe manifestations, such as haemophagocytic lymphohistiocytosis (HLH), a rare and potentially fatal immunological syndrome, have also been reported in ehrlichiosis.[13][14] Signs and symptoms include hepatosplenomegaly, fever, and rash.
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