Clinical History

A previously healthy 45-year-old male noted the abrupt onset of severe shaking chills, fever, headache, and generalized myalgias. This progressed over 3-4 days with the addition of mild upper respiratory symptoms. At initial presentation to his primary care physician, he was placed on doxycycline 100mg bid for an undetermined systemic infection. Symptoms worsened over the next two days and the patient was admitted to the hospital with a consult to the infectious diseases service.

Admission history indicated an active male who worked as an animal inspector for the past ten years, often examining diseased animals throughout the United States. Approximately one week prior to the systemic symptoms he experienced 1-2 days of right conjunctival irritation and tender right cervical lymphadenopathy after being splashed in the eye with bodily fluid from a rabbit. He did not own any pets and had no contact with dogs or cats. He denied any significant past illnesses or surgeries. Admission physical findings included fever (40 degree C) with mild tachycardia and tachypnea, a mild stiff neck and decreased breath sounds on the right. A CT scan of the chest and abdomen showed a right lower lobe infiltrate. A lumbar puncture revealed normal CSF parameters