{"ops":[{"insert":"A 35-year-old man presents with fever for 14 days, along with fatigue, malaise, generalized arthralgia and myalgia, and a diffuse headache for the same duration. No other symptoms are present. He has been self-medicating himself with acetaminophen and has not sought medical attention thus far.\n \nHe returned from a week-long hiking trip in rural Massachusetts around three weeks ago. He does not recall being bitten by insects. The several friends and family who traveled with him are healthy.\n \nThere is no contact history with people with similar symptoms. He has a single stable long-term sexual partner. His medical, surgical and family histories are unremarkable. He does not smoke and only drinks socially.\n \nHis basic investigations are as follows:\n \nWBC: 5,100\/mm3 (4,600-11,00)\n Neu: 45% Lym: 37%\nHb: 10.5 g\/dL (11-18)\nMCV: 90 fL (80-96) \nMCH: 30 pg\/cell (27-33)\nPlt: 196,000\/mm3 (150,000-450,000)\n \nALT: 80 IU\/L (7-45)\nAST: 72 IU\/L (8-48)\nTot. bilirubin: 1.5 mg\/dL (0.2-1.2) \nDir. bilirubin: 0.3 mg\/dL (0.1-0.4)\n \nReticulocyte count: 8%\nSerum LDH: 800 IU\/L (105-333)\nDirect antiglobulin test: negative\nIndirect antiglobulin test: negative\n \nRenal functions, chest x-rays, and a urinalysis are all normal.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-253_en.png"}},{"insert":"\n"}]}
2
Investigate
Thick + thin blood films
{"ops":[{"insert":"Thick blood films reveal numerous intraerythrocytic parasites.\n \nThin blood films show reticulocytosis and pear-shaped trophozoites with blue cytoplasm and red chromatin. Multiple ring forms are identified, without hemozoin deposits. Maltese crosses are present. The parasitemia level is 0.3%. No morulae are found in the white blood cells.\n"}]}
