An 18-year-old woman presented with fever and headache. The patient's fever began 3 weeks ago. Her temperature was 102°F, and she had shaking chills, headache, myalgia, and lassitude that lasted about 5 days and then resolved. After a 5-day hiatus, the identical symptoms returned and lasted for another 5 days, and then remitted for 5 days before recurring yet again. The headache was associated with photophobia and a slightly stiff neck.
Medical history: Tetralogy of Fallot repair in childhood. Received numerous bug bites during a traveling trip. Physical examination revealed: Vital signs: temperature: 102°F, pulse: 140 beats/min, General: thin and ill-appearing Headache is light-sensitive and worsens with flexion. Heart: grade 3/6 systolic and 2/6 diastolic with harsh murmurs Diagnostic Evaluation WBC: 11.5 x 10 3 /mm 3 Differential: 4% bands (machine differential) Platelets: 245,000/µL…
