Board Review: Potpourri
37 year-old male presents to the ED with four days of fevers, chills, abdominal pain, myalgias. Denies nausea, vomiting, and diarrhea. No known sick contacts. Works as a landscaper. Sexually active with one partner who is asymptomatic. Vitals on arrival: Tempt 100.9F, RR 16, BPM 115, BP 120/74, Sp02 100% RA. On exam, patient has diffuse lower abdominal tenderness. Labs demonstrate Na 131, AST 140, ALT 147, Hgb 14, Platelets 142, Lactate 1.4. CT Abd/pelvis negative for acute surgical pathology. What is the most appropriate treatment at this time?
A. Vancomycin and Cefepime
D. Azithromycin and Ceftriaxone
Answer: B- Doxycycline
This patient is presenting with symptoms and laboratory studies concerning for tick-borne illness. Patients that are frequently outside are at higher risk of infection. These patients present with vague symptoms including fevers, chills, myalgias, headaches, abdominal pain. Laboratory studies often demonstrate transaminitis, thrombocytopenia, hyponatremia, leukopenia. Diagnosis is made by PCR, blood smear, or immunofluorescence. Treatment is as follows:
Prophylaxis: Doxycycline 200mg once
Treatment: 14-21 days of one of the following
Doxycycline 100mg BID
Amoxicillin 500mg TID
Cefuroxime 500mg BID
Azithromycin (500mg day 1 followed by 250mg daily) plus Atovaquone (750mg BID) for 7-10 days
Doxycycline 100mg BID for 10 days
Doxycycline 100mg BID 10-14 days
Rocky Mountain Spotted Fever:
Doxycycline 100mg BID for 5-7 days
Bridewell, R. (2019). Lyme Disease. In <http://www.emdocs.net/em3am-lyme-disease>.
Kitch, B. B., & Meredith, J. T. (2016). In Tintinalli's emergency medicine: a comprehensive study guide (pp. 1085–1090). essay, Mc Graw-Hill Education.