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Internal Medicine

Public·45 members

In February, 27-year-old man is seen for fever, myalgias, arthralgias, and headache of one-day duration. Two days before he became ill, he returned from a skiing vacation with friends in California.

They stayed in a cabin in the woods that had been uninhabited for many months. Rodent droppings were evident in the cabin when they arrived. He has been taking NSAIDS for muscle pain precipitated by skiing.

Exam is notable for fever and meningismus.

A CSF exam shows 400 white blood cells, 97% lymphocytes. The CSF protein is 98, and the glucose is 30 with simultaneous blood glucose of 88; Gram stain is negative.

Which one of the following is the most likely cause of his illness?

  • NSAID-induced aseptic meningitis

  • Lymphocytic choriomeningitis virus

  • Enterovirus

  • Hantavirus

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