Quiz: Can you diagnose these muscle spasms in a 19-year-old-male?
Take this Contemporary Pediatrics quiz, and see if you can correctly diagnose the patient in this case study. Submit your answer to see if you were correct.
Figure - Image credit: Author provided
Welcome to this Contemporary Pediatrics quiz. Take a look at the following case below. After reading through the description, choose a multiple choice answer and try to guess the correct patient diagnosis.
This case was provided by: Abby Kabo, William Kenan, and Hanna S. Sahhar, MD, FAAP, FACOP.
Case:
A 19-year-old male presents to the emergency department (ED) with headache and fever of 4 days’ duration. Six days earlier, his left palm had been punctured by a rusty nail (Figure).
He had cleaned the wound with alcohol and hydrogen peroxide and applied a Neosporin dressing. Two days later, he complained of fever (max 103 °F), headache, abdominal muscle spasms, sweating, and vomiting.
Upon questioning, it was determined that his symptoms also included abdominal soreness, shortness of breath, and chills, but he denied rash, dizziness, heart palpitations, chest pain, cough, or any neurologic symptom.
Previous medical and surgical history were unremarkable, and the patient had had 5 lifetime doses of DTaP and 1 dose of Tdap 7 years before the injury.
At the ED, the patient was given a bolus of normal saline, intravenous penicillin G, and diazepam and was then admitted to the hospital.
Labs/Findings:
Upon admission, patient vitals were blood pressure 145/98 mmHg, pulse 137 beats/minute, temperature 100.6 °F, and respiratory rate 26 breaths/minute, with 100% oxygen saturation on room air. The wound was examined and showed no evidence of cellulitis or erythema. A comprehensive metabolic panel (CMP), complete blood count (CBC), lactic acid, blood culture, blood ethanol, magnesium, lipase, lactic acid reflex, prothrombin time (PT)/ international normalized ratio (INR), partial thromboplastin time (PTT), lipase, and troponin were all normal. EKG showed sinus tachycardia, and chest x-ray was unremarkable.
What is the diagnosis of this case?
Reference:
Kabo A, Kenan W, Sahhar HS. Muscle spasms in a 19-year-old male. Contemporary Pediatrics. March 14, 2023. Accessed January 26, 2024. https://www.contemporarypediatrics.com/view/muscle-spasms-in-a-19-year-old-male
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