Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

A 45-year-old man from Poughquag, NewYork, who was on a hunting trip in Manitoba, Canada, presented to a hospital with headache, fever, myalgias, and shortness of breath. His history included are mote traumatic splenectomy and frequent deer hunting and taxidermy. The finding sofan initial evaluation wer unremarkable, except that hypoxia with ahemoglobin saturation of 77% was documented and hypoxemia was confirmed by arterial blood gas analysis. Anelectrocardiogram and initial chest radiograph did not reveal any significant abnormalities, although follow-up chestradiographs had findings that indicated mil pulmonaryedema. The results of routine laboratory investigations indicated lymphopenia (cell0s./4L_) an1d09thrombocytopenia (c4e4lls_/L1) 0.B9iochemistry showed elevated liver transaminase levels (aspartate aminotransferase level, 217U/L; alanine transaminase level,117U/L) and a moderately elevated conjugated bilirubin level (28 mmol/L). Initially, a diagnosis of pulmonary embolismorcardiogenic pulmonary edema was considered, but ventilation-perfusion scans did not reveal any segmental ventilation- perfusion abnormality, and anelectro cardiogram andechocardiogram (performed 2 days after presentation) revealed no evidence of cardiac dysfunction orischemia. A routine Geims a blood smear that was performed to evaluate the hematological abnormalities that were noted by the analyzer confirmed the automated differential, and neutrophilic inclusion were noted (Figure1). A polymerase chain reaction confirmed the diagnosis.

Topic:
Issue Section:
Photo Quiz
You do not currently have access to this article.
Download all slides