Infectious Disease In A Cross Country Runner

Abstract

HISTORY: A 20-year-old cross country runner experienced marked fatigue for four days during which he continued to run and go to class. On day 5 he began to experience pain in his lower jaw bilaterally. The pain increased markedly on day 6, and he noticed his cheeks began to look "puffy." He sought a dental evaluation which was normal, but was instructed by the dentist to follow up with a medical doctor. He continued to feel poorly. His symptoms progressed to a maximum temperature of 38.8°C, ear pain, severe headache, inability to move his neck and profuse vomiting with a 12 pound weight loss. Although on day 14 his symptoms began to improve, he sought medical attention in the ER. PHYSICAL EXAMINATION: Examination in the ER revealed fever and marked bilateral parotid swelling and tenderness. Heart, lung and abdominal exams were normal. The patient did not exhibit any neurological symptoms or signs. DIFFERENTIAL DIAGNOSIS: viral infection (mumps), bacterial infection, salivary calculi, tumors TEST AND RESULTS: Labs -CMP, CBC within normal limits CT scan of neck -no abscess seen FINAL/WORKING DIAGNOSIS Mumps TREATMENT AND OUTCOMES Given intravenous fluids in ER as well as antibiotics, although presumed diagnosis was mumps. Close follow-up. Isolation of the patient. Notes from the school were sent out to students who had exposure to the patient. Immunization of students not immunized. Gradual return to play.