TWiP solves the case of the man in the Malaysian city of Kucheng who presents with left arm swelling, and presents a new case for you to decipher.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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New Case

We are still in Kuching, Malaysia in the northern part of the Island of Borneo. This is the Sarawak portion of Malaysia. A man in his late 30s is admitted to the hospital in December with daily fevers that last for several hours and shaking chills. He had previously been healthy with no medical problems. He lives in the city and works in an office, however, in the few weeks prior to getting admitted he was visiting the jungle. Apparently not too far outside of Kuching, one can go up into the jungle and see Orangutans. He had gone into the jungle but this was 2 weeks prior to the onset of symptoms. Since then he reports no unusual exposures. He lives with his wife and children and they are all healthy. A few days prior to admission he noted fever, chills, and a headache. He is a little nauseated but no vomiting.

On exam he has a fast heart rate and appears ill. His respiratory rate is increased and he is not febrile on admission but later does have fever. No enlargement of the liver or spleen on exam. Otherwise unremarkable.

His labs are notable for low white blood cells, anemia, and a platelet count of less than 50k per microL. His coagulation studies are abnormal, serum creatinine is elevated, and there is elevation of his serum aminotransferases.

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Music by Ronald Jenkees