In this podcast we discuss the case of:

A 28 year old female presented on a weekend after feeling unwell for about 5 days, she thought she had a cold/flu but it wasn’t improving so she came to the ED. She complained of very non-specific symptoms: mild headache, lethargy, felt a bit feverish, mild joint stiffness/pain. There were no coryzal symptoms - runny nose, cough, sore throat or sneezing.

She had not felt like eating and drinking but was able to ‘force’ herself and was able to keep food/fluids down. She had been passing urine normally with no symptoms. There was no nausea or vomiting. There was no neck pain or headache or photophobia.

Past Medical History : Normally fit and well

Drug History: Nil regularly, NKDA.

Social History: Independent, lived alone, she worked in IT and she was in the Army Reserve. No recent foreign travel.

Examination
She looked ok. Had normal vital signs, not tachycardic, normal BP, temperature of 37.8.

ENT - normal, no lymphadenopathy.
Respiratory  - chest clear, normal RR, Spo2 98%.
Abdominal  - Soft, non-tender, no organomagely, bowel sounds normal.
CNS - normal. Normal Gait. Normal neck movements, no photophobia. Kernig’s negative.

She reported no rashes but did mention that she had a red patch on her LEFT upper calf.
Skin - approx. 6cm x 6cm red ‘bullseye’ patch popliteal fossa

Further questioning she had been on exercise with the Army 10days previously.

Have a listen to the podcast for the differential diagnoses and to find out what happened.

Music by BenSound.