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Case of the Month - December 2012

Fever in an expatriate traveller - Dr J Klotnick, SASTM

A 59 year old socio economic consultant, working in the Philippines (mainly in Manila) for the past six years, felt unwell one morning. He took his own temperature and found it to be 38.6oC. He decided to return to South Africa for medical assistance.

He has no medical history of note and was not on any chronic medication. He was not on malaria chemoprophylaxis. Details of the findings on clinical examination are scanty other than he reported that his sinuses were painful.

A blood count was performed and this was normal apart from a thrombocytopaenia. He was diagnosed as having sinusitis and placed on moxifloxacin 400 mg daily.

He did not improve and was seen two days later by another practitioner (day 3). He reported that his throat was sore and his sinuses still felt inflamed. He was nauseous and was retching. There was no diarrhoea. He did not have any myalgia or arthralgia.

On examination he was pyrexial (38.3 oC) and fully orientated. No abnormalities were noted on examination. His urine was of a normal colour and there was no indication of a urinary tract infection on urine dipstix testing.

Question 1: Was sinusitis an appropriate diagnosis in the first instance?

Continue to Answer 1