The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
The parents of a 13-year-old boy bring their son to the emergency department. He is rolling his head and is seemingly unaware of his surroundings. They say that he has a fever and is "acting strange."
The boy had been in his usual state of excellent health until 2 days ago, when he complained of a headache during a car trip back from a vacation. For most of the 4-hour drive, he slept restlessly in the back seat. The family, which consists of the boy, his parents, and two younger siblings, had enjoyed a 1-week vacation at an Indiana water park resort. They spent most of their time swimming in the artificial lake and hiking. A diving champion, the boy concentrated on perfecting his diving technique in the lake; he also went snorkeling.
The family members all used insect repellent and sunscreen while outdoors. They also checked each other for ticks. They always ate at the resort's four-star restaurant. As far as the parents know, no diners became ill. No other family member is currently ill. They have no pets at home and have not had any exposure to feral or domesticated animals.
Yesterday, the boy lay quietly on the couch and watched television. He had a headache and was also nauseated. His mother reports that he felt warm to the touch just before he went to bed, and she gave him ibuprofen. In the morning, hearing "funny noises," his parents entered his bedroom. He was lethargic and incoherent. Yellow vomitus and urine colored the bedsheets. They immediately wrapped him up and brought him to the emergency department by car.
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Cite this: Paul P. Rega. 13-Year-Old Boy Unaware of His Surroundings - Medscape - Sep 14, 2023.