Personal Data ICB 45/M Filipino Living in Gimba, Nueva Ecija Farmer

History of Present Illness 7 days PTA Patient waded in swamp water as he work in his farm Couple of hours after, patient experienced fever of 37.8°C and chills, body malaise He also complained of back pain and myalgia Throbbing headache on frontal area, 7/10 Took paracetamol, 500mg/tab every 4 hours which gave relief to fever and chills Took alaxan, 500mg/dl which provided relief for back pain and myalgia Headache not resolved

6 days PTA Recurrence of fever, 39°C and noticed tea -like urine in the morning This prompted patient to consult at a local clinic and was given an impression of infection of unknown origin (pero UTI sabi patient natin, cant decide what to write) Unrecalled medications were prescribed, to which patient claimed to be compliant

5 days PTA Fever and other symptoms were relieved except for headache Throbbing headache persisted Vomiting of recently ingested food was reported

4 days PTA Headache persisted and there was recurrence of fever This prompted consult at USTH OPD Laboratory workups were requested No medications were given yet

2 days Persistence of headache Wife notices jaundice on patient This prompted consult at USTH-CD ER

Review of Systems (-) weight change, (-) fatigue, (-)dizziness (-) pruritus, no petichial rashes (+) new scar/wound on right toes No epistaxis, no nasal discharge No oral lesions, no gum bleeding (-) deafness, tinnitus or ear discharges (-)sorethroat or tonsillitis (-) neck stiffness (-)PND, orthopnea (-)cosntipation nor diarrhea (-)tremors, no heat nor cold intolerance (-) seizures (-)easy bruisability (-)lymphadenopathy

Family history (+) HPN mother and sibling (-) Dm

Past medical history (-) DM (-) HPN (-) asthma (+) pnemonia(2001) (+) enucleation on right eye due to trauma(1970s)

Personal History 30 pack years smoking history(stopped on 2002 bec of pneumonia) Alcoholic drinker-occasional Denies illicit drug use Mixed diet

Salient features Fever and chills Body malaise Backpain Headache frontal area Vomiting