A 20-year-old male with a history of ear discharge for 8 years presented with a fever of 40.5°C lasting for the past 2 weeks. He also reported a severe persistent headache and a productive cough with bloody sputum. DIAGNOSTIC JOURNEY
Now, it’s time to ask two questions:
-Where does the disease live? We have two localizing signs: cough and headache. -What is the true time course—2 weeks or 8 years? The problem can be truly subacute or chronic with recent complication.
Let’s dig deeper into this case!
Patient lives in the malaria-endemic area. On exam, he has nuchal rigidity. There’s also active discharge from right ear, and a perforated tympanic membrane. CBC revealed a WBC of 4K with 81% neutrophils, hemoglobin of 16.7, and platelets of 51K. Blood smear showed toxic granulation of neutrophils and platelet aggregation.
There’s a high chance that we are dealing with pyogenic bacterial infection.
So where’s the source?
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