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.
A 35-year-old man with no significant past medical history presents to an outpatient primary care office with a headache that started 4 days earlier. He also reports fatigue, fever, and chills. His wife notes that he is confused. Vital signs at the office visit show a temperature of 101.9 °F (38.8 °C), heart rate of 93 beats/min, blood pressure of 136/82 mm Hg, respiration rate of 18 breaths/min, and oxygen saturation of 97% on ambient air. He undergoes a COVID-19 polymerase chain reaction test, which is negative, and returns home.
Because his headache and fever are worsening, the patient presents to the emergency department later the same day for further evaluation. He reports taking acetaminophen at home, which mildly improved his symptoms. Additionally, he has diffuse anterior chest wall pain, which he describes as soreness.
He is not currently taking any medications. He has smoked one pack of cigarettes daily for the past 10 years and drinks alcohol on occasion, but he does not report any illicit drug use. He has no family history of cardiac disease and has had no surgeries in the past. He reports a known allergy to penicillin.
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Cite this: Priyanka Ghosh, Saurabh Sharma. 35-Year-Old With Confusion and Headache - Medscape - Oct 23, 2023.