Level 2: Fever – Contrasting Case #2: Patient Information

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 an 80-year-old female who is brought to the ED via ambulance. She resides at a local assisted living facility, where a caregiver noticed her mental status to be abnormal this morning. The caregiver took vital signs, and called an ambulance after noting the patient’s temperature to be 102F. The patient states that she “feels funny,” but denies any other symptoms. Her PMH is significant for DM2, for which she takes glipizide, and recurrent UTIs.

Physical Examination –
The patient is lying supine on an exam table and is intermittently awake. Temperature is 38C, HR 116, BP 100/66, RR 20. The patient appears lethargic, but responds to verbal stimuli. She is oriented only to person. Tachycardic heart sounds without murmurs, rubs, or gallops on auscultation. No JVD, no carotid bruits. Breath sounds clear bilaterally. Abdomen is soft, nontender, nondistended, and bowel sounds are present in all quadrants. No rashes or skin lesions. Introduction of Foley catheter produces 500 mL of turbid urine.