The Clinical Problem Solvers Episode 401 – #IDLove – Fever & AMS
Jun 17, 2025
In this engaging discussion, infectious disease expert Varun Phadke provides insight into a complex case involving a 50-year-old man with fever, altered mental status, and diarrhea. The conversation highlights the intricate link between gastrointestinal and neurological symptoms. Phadke tackles challenging diagnoses, including alcohol withdrawal and the intricacies of Legionella pneumonia. Listeners will appreciate the emphasis on detailed clinical reasoning and the importance of comprehensive evaluations in complex medical cases.
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Interpret Profound Encephalopathy Carefully
- Profound encephalopathy in a previously healthy 50-year-old suggests severe injury, commonly infectious or structural causes.
- Infectious causes are prioritized with high fever and diarrhea, necessitating CNS versus non-CNS infection evaluation.
Infectious Multi-System Involvement Insight
- Infections affecting multiple systems like CNS and GI usually involve viruses or pathogens causing widespread manifestations.
- Diarrhea and neurological symptoms together raise suspicion for pathogens such as Listeria.
Approach Alcohol Use & Crackles
- Consider alcohol withdrawal delirium in patients with alcohol use presenting with confusion and fever; benzodiazepines may be helpful.
- Be cautious about attributing lung crackles directly to pneumonia without further confirmation; aspiration in encephalopathy is common.
