a 23-year-old male presented to the er with a 5-day history of fever, headache, sore throat, muscle pain, nausea, and diarrhea. he described his headache as a 10/10 on a pain scale, and was worsened by bright lights, movement, or noise. He had migraines in the past but stated this felt different. He said there was not a prior history of head injury, chest pain, or ear pain. He does not have abdominal pain, dysuria, or a skin rash. No recent alcohol or illicit drug use, travel, or exposure to ticks. Upon physical exam, he had right-sided tonsillar exudates and swelling. Even though neck pain was described with his headache, the neck was supple. Following lumbar puncture, 4 nucleated cells and 87% lymphocytes were shown. CSF protein and glucose were within normal limits. He had a normal white blood cell count but a low blood lymphocyte count of 720 cells/uL (normal is 1500 - 5000/uL). Chest radiograph came back normal. CSF was sent for herpes simplex virus (HSV) PCR and for bacterial culture. No organisms were detected upon gram staining. Urine was obtained for bacterial culture, chlamydia, and gonorrhea testing. Blood was drawn for routine bacterial cultures and Monospot test. Upon further questioning about the patient's history it was revealed he was sexually active as a man who has sex with men and unreliable condom use. The patient's last HIV test was 2 months ago and was negative. Patient was admitted for further evaluation. What is most likely the patient's diagnosis?
a 23-year-old male presented to the er with a 5-day history of fever, headache, sore throat, muscle pain, nausea, and diarrhea. he described his headache as a 10/10 on a pain scale, and was worsened by bright lights,
movement, or noise. He had migraines in the past but stated this felt different. He said there was not a prior history of head injury, chest pain, or ear pain. He does not have abdominal pain, dysuria, or a skin rash. No recent alcohol or illicit drug use, travel, or exposure to ticks.
Upon physical exam, he had right-sided tonsillar exudates and swelling. Even though neck pain was described with his headache, the neck was supple. Following lumbar puncture, 4 nucleated cells and 87% lymphocytes were shown. CSF protein and glucose were within normal limits. He had a normal white blood cell count but a low blood lymphocyte count of 720 cells/uL (normal is 1500 - 5000/uL). Chest radiograph came back normal. CSF was sent for herpes simplex virus (HSV) PCR and for bacterial culture. No organisms were detected upon
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