67F with T2DM (well-controlled w/o insulin), hypoTh, asthma, presented after 3d n/v, with lightheadedness, weakness, low-grade fever, and a fall.
Denies hitting head.
At baseline previously.
100.3F at home. No sick contacts. Non-productive cough, also x3d.
No new meds. No known inciting events.
Woke up and called a friend (not found down).
OSH - hypotensive, given zosyn and 2L LR
Hypotensive, tachypnea On pressors
tachycardic, tachypneic, fairly warm, AOxSelf, still following commands
Ehrlichiosis! Tx w doxy.
Time to diagnosis is delayed in pts who require ICU admission (Kuriakose 2020, JAMA Network Open, e202577)
For RMSF, no need to send w/u unless clear geographic exposure.
Send Ehrlichia/anaplasmosis PCR, smear, consider babesia.
Lyme: should have travelled north of the Mason-Dixon line, not endemic to TN.