Diarrhea, Fever, Hypoxia, and Rash in a House Officer

Abstract

DR. LEE COHEN. A 26-year-old male physician was in good health until August 1989, when he had five episodes of watery diarrhea over 24 hours after eating in a Mexican restaurant. Six days later he developed fever to 39.7?C that was associated with chills, malaise, myalgias, headache, and sore throat. The fever persisted for 72 hours, at which time he presented to the emergency room at UCLA Medical Center and was given erythromycin for possible streptococcal pharyngitis. He subsequently developed profuse, watery diarrhea, which occurred as frequently as every 15 minutes. He returned to the emergency room on the following day because of persistent diarrhea, sore throat, exertional dyspnea, and nonproductive cough. He denied a history of rash, stiff neck, chest pain, or abdominal pain. He was admitted to the hospital. The patient was a house officer in the department of internal medicine on rotation at a local county hospital. He denied known exposure to patients with communicable diseases, and no member of his household had a similar illness. The patient asserted that he had not traveled recently, gone camping, ingested raw foods or milk, been exposed to animals, or been bitten by arthropods. He had received routine childhood immunizations, and the result of a test for purified protein derivative within the preceding year was negative. He had not been hospitalized recently. Physical examination showed a well-developed,