Altered mental status with hemorrhagic fever

Scenario overview A 33-year-old man is brought in by EMS to a tertiary care center in the ED after being called by his significant other. The man was recently away in Africa working for an international aid organization and then visiting his partner's family in Panama. He has been complaining of high fevers, with a maximum temperature of 104.7°F at home, headache with eye pain, myalgias and joint pains. These symptoms started about 2 days after he returned home and have been getting worse. He has complained of worsening muscle and joint pains that are very severe and not relieved by NSAIDs that he was taking for the pain. His partner has not heard from him all day and after working late she came home to find him on the bathroom floor, minimally responsive. He arrives on 100 O₂ delivered by NRB mask and on a cardiac monitor. During the case the partner is very upset but can be calmed by team member to provide history. Patient travels extensively, including his most recent trip to Africa, from which he returned 2 weeks ago. He has had a number of tropical diseases before because of his work, and all she remembers is malaria and when prompted dengue.