Review the clinical scenario presented and respond to questions.

A 22-year-old college student arrives at the college health center with complaints of high fever, vomiting, headache, and backache. She reports she has recently returned from Germany after a 1-week vacation with her boyfriend. One of the visitors at the home of some friends left the party vomiting and febrile. Her boyfriend has demonstrated no unusual symptoms. What typical laboratory studies would be ordered to help in the diagnosis of this presentation? Make a list of possible differential diagnoses.

The patient's white blood cells are moderately elevated, and the urine is clear with an elevated specific gravity. Specimens for sexually transmitted cultures are obtained; however, the examination result is normal. The rest of the findings are essentially normal with the exception of some regional lymphadenopathy. The patient is sent home with antibiotics to cover a possible sexually transmitted disease. She is told to force fluids, use acetaminophen for fever, and return if she has any further problems or symptoms. Is there anything in the symptoms described that are alarming or should be reported to the CDC?

Two days later the patient returns with a macular rash on her face, legs, and hands. She states that it began this morning and she continues to be febrile with little improvement in other symptoms. What further testing needs to be done at this point? What, if any, change would you make in your differential diagnoses? Is there anything reportable at this point?

The patient is kept in the observatory as a precaution. By morning, the macules have progressed to vesicles in all the lesions, however, no new lesions are noted. What are your next steps? Should the patient be reported or hospitalized? What is a likely diagnosis, and why?