A 21-year-old male college student presents to the emergency department with a 2-day history
of fever, severe muscle and joint pain, nausea, and vomiting. He spent his winter break traveling
in South America and returned 4 days ago. On examination he has a temperature of 39.4°C
(103.0°F), gingival bleeding, lower extremity non-pitting edema, right upper quadrant
tenderness, a diffuse maculopapular rash, muscle tenderness, and petechiae on his extremities.
labs:
- low WBC
- low platelets
- high hematocrit
- high AST and ALT (same range)
- normal bilirubin
- no jaundice
A) Hepatitis A
B) Yellow fever
C) Dengue fever
D) Typhoid fever
E) Influenza