Presentation
A man in his mid-60s presented with fever, neck stiffness and headache. Symptoms started 10 days prior with an acute onset of headache after being on a boat for several hours. The patient reportedA man in his 60s presented with fever, headache and neck stiffness. CSF showed elevated nucleated cells with mononuclear predominance; no organisms were seen on CSF Gram stain or grown in culture. being outdoors frequently on fishing trips. He lives in a flooded area with potential exposure to mice when his property floods. He has frequent exposure to mosquitoes, but no known tick bites or skin rashes. The CSF cell count showed elevated nucleated cells with mononuclear predominance. No organisms were seen on the CSF Gram stain, and no organisms grew in culture. The meningitis encephalitis PCR panel was negative. Lyme disease screening was negative and arboviral serologies were negative. The provider noted the patient had conjunctival suffusion and ordered an additional serology test, which revealed the diagnosis.
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Author Information
Rachel Bosserman, Ph.D., D(ABMM), Clinical Microbiologist, SSM Health St. Mary's Hospital—Madison.
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