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 66-year-old man who presents to the ED with a 2-day history of fever and headache. No temperatures were recorded at home, but he has felt very warm to touch. He came in at his wife’s urging after she noticed he seemed confused and irritable this afternoon. He endorses nausea and neck stiffness, but denies photophobia. No myalgias, abdominal pain, vomiting or diarrhea. No cough, chest pain, or sore throat. No urinary symptoms. No dermatologic symptoms. He has not received any age-appropriate immunizations. His PMH is otherwise unremarkable. FMH, SH unremarkable.
Physical Examination –
The patient is lying on a gurney in the right lateral recumbent position and appears in moderate distress. Height: 183 cm; Weight: 83 kg; BMI: 24.8 kg/m2; Temperature 38.8C, HR 96, BP 132/82, RR 16. Positive Brudzinski sign and nuchal rigidity; Kernig sign absent.