Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 26-year-old man who presents to the urgent care clinic with a 3-day history of fever. He reports fatigue that has progressed over the past 3 weeks, but no other symptoms. No recent history of skin infection, although he asks if there is any association with the “tiny red and purplish dots” he has noticed over his lower extremities for the past week or so.
Physical examination –
On exam the patient appears alert, oriented, and in no acute distress. Height: 183 cm; Weight: 83 kg; BMI: 24.8 kg/m2; Temperature 38.8C, HR 96, BP 132/82, RR 16. Notable conjunctival pallor; mucous membranes pale but moist. Inspection of skin reveals diffuse, non-palpable petechiae over the bilateral lower extremities.