An otherwise healthy 20-year-old woman presents to the ED with complaints of 1 day of headache and fever with associated nausea, vomiting, and a diffuse red rash. She reports that she has been on spring break for the past week, has been drinking heavily, and has been spending most of each day in the sun, but she has used SPF 30 sunblock and does not remember getting sunburned. Her last menstrual period began 3 days ago. She reports that she forgot her tampons at home and borrowed one from her friend, which she has left in for the past 2 days. She denies any recent sexual activity. Examination is notable for a diffuse macular erythematous rash resembling sunburn that covers the majority of her body, including her palms and soles. Her neck is supple, and she does not exhibit any photophobia or signs of intoxication. Twenty minutes after initial presentation, she becomes lethargic, and her vital signs are temperature 39.6°C (103.3°F), heart rate 115/min, blood pressure 84/48 mm Hg, and respiratory rate 18/min. What is the most likely diagnosis?
- (A) Alcohol poisoning
- (B) Heatstroke
- © Neisseria meningococcemia
- (D) Rocky Mountain spotted fever
- (E) Toxic shock syndrome
0 voters