CASE STUDY M-5
An 18-year-old female college student complains of fever, chills, headache, and vomiting. She presents to the college health service ED, where she is examined. She appears lethargic, and her temperature is 102°F. Blood is drawn for a CBC and culture, urine is collected for analysis, and a serum chemistry profile is ordered. A lumbar puncture is performed, and cloudy CSF is collected. Laboratory data follow:
Complete Blood Count
WBC count: 20.0 x 10⁹ (normal range 5-10 x 10⁹)
Differential: Marked neutrophilia with shift to immature forms (shift to the left)
CSF Results
WBC count: 1200 cells/mL with 95% neutrophils (reference value: 0-5 lymphocytes)
Glucose: 25 mg/dL (decreased, compared with blood glucose value)
Protein: 150 mg/dL (increased)
Other Data
Gram stain: Many neutrophils, Gram-negative diplococci in pairs
Urinalysis: Increased protein, few RBCs, few granular casts
Serum chemistries: Within reference values
Critical Thinking Questions
1. What characteristics of the patient presented in the case history would provide clues as to the potential infectious agent?
2. Explain why the physician ordered the chemistry panel in conjunction with the other tests.