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EM@3AM: Septic Abortion

A 24-year-old female G4P1 who is 9 weeks pregnant presents with abdominal pain and vaginal bleeding for 3 days. Vital signs include HR 115, BP 100/76, T 38.7, RR 13, SpO2 99% on RA. She is ill-appearing and has tenderness to palpation of the bilateral lower quadrants and suprapubic region. Pelvic exam reveals blood in the vaginal vault and foul-smelling discharge from the cervix with no other abnormalities. What is the likely diagnosis?

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    EM@3AM: Ehrlichiosis

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    A 70-year-old male with presents with 5 days of fever and 3 days of anuria and malaise. He also notes worsening abdominal distention and shortness of breath. He found and removed a tick 3 weeks ago and another one 1 week ago. Labs reveal WBC 2,200 cells/microL, HGB 11.2 g/dL,
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    Multiple sclerosis

    Immune-mediated, demyelinating disease, separated in time and space, females > males

     

    Presents with exacerbations, med complications, or some other condition (most common)

     

    New neuro symptom = true exacerbation -> steroids

     

    Worsening of prior neuro symptoms = pseudoexacerbation -> find and treat underlying trigger (infection)

     

    Avoid fever; worsens symptoms

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