Case 11

A white male, 17 years of age presented at the emergency room with a severe headache, vomiting, and a stiff neck with pain running up his back. On admission, his temperature was 101F. The young man appeared to have trouble hearing during the nurse’s interview and also seemed to have trouble concentrating.

The history revealed that the young man is a wrestler for the local high school team. He had felt as though he were getting a cold the past few days, since his last meet in Hicksville. He did not smoke or drink, but he had attended a party two days earlier thrown by his girlfriend and the other cheerleaders to celebrate his victory in the sectionals. He had been holding his weight at 162 for the season, so he ate little and did not drink on the day of meets (today is a day of the meet).

On physical exam, the physician noticed several areas of small purplish spots on the skin of the back, thigh and arm. The boy thought those were from wrestling.

  1. Which of the following is the most likely diagnosis?
    1. Neisseria gonorrhoae induced meningitis
    2. E. coli induced meningitis
    3. Neisseria meningitidis induced meningitis
    4. Streptococcus pneumonae induced meningitis
    5. LaCrosse encephalitis
      6.
  2. Which of the following was a critical factor in your choice of diagnosis?
    1. The fact the he is a wrestler and he does not eat or drink much.
    2. The headache, vomiting, stiff neck, fever and purplish spots.
    3. The party he went to with the cheerleaders.
    4. His trouble hearing.
    5. The cold symptoms.
      6.
  3. Which of the following will likely happen if he is not treated?
    1. He will continue to have a fever and stiff neck for a few days and recover.
    2. His symptoms will progressively worsen until he develops shock and dies.
    3. He may get better in a few days, but will likely have permanent hearing loss.
    4. It is impossible to tell, because not enough data is available for an assessment of his condition.
    5. He will likely recover from the acute illness, but develop chronic arthritis later.
      6.