Challenger Quick Quiz 2013.05.15

A 19-year-old female presents with a complaint of sudden onset of fever, headache, vomiting, and myalgias.

A 19-year-old female college student is signed out at shift change as having presented towards the end of the previous shift with a complaint of sudden onset of fever, headache, vomiting and myalgias. She is currently menstruating. Her T is 39.2°C, HR 130 and BP 88/52. She has a diffuse erythroderma on exam, but no petechiae or purpura on her extremities and no signs of an abscess. She received an intravenous normal saline bolus, and the following tests were sent: rapid streptococcal (strep) antigen testing, CBC, chemistries, and a pregnancy test. Her rapid strep test already returned negative, and her vital signs have improved.

Question:

With further evaluation, which of the following is most likely?

a) History of travel to Rocky Mountain or Appalachian states
b) History of a buttocks abscess in the past
c) History of other dorm-mates who are ill
d) Positive Monospot
e) Abnormal liver function tests (LFTs), creatinine, platelets

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