Case 1-2013 "Rabies"

10:55| "A 63-Year-Old Man with Paresthesias and Difficulty Swallowing", a CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL by David Greer and colleagues.
A 63-year-old man was admitted to this hospital because of paresthesias, difficulty drinking liquids, and anxiety.
4 days before admission, aching developed in the left elbow, which improved with ibuprofen. The next day, right-elbow discomfort occurred, and he had decreased appetite. Two days before admission, he noted difficulty forming words, mild light-headedness, and mild recurrent pain in both elbows. An attempt to drink a glass of water precipitated a gagging sensation. He stopped drinking liquids and became increasingly anxious. One day before admission, he was unable to shower because of increased anxiety and noted intermittent decreased fluency in his speech and pruritus at the nape of his neck. He had no history of animal bites; however, bats had been seen in his home.
On examination, the patient was intermittently very anxious and hyperventilating. When given a cup of water or juice, he gagged as the cup neared his mouth and coughed while attempting to drink.
The approach to a patient with an altered sensorium involves a careful history taking, with particular attention to the time course. There are several considerations in the formulation of the differential diagnosis. These include tetanus, diphtheria, botulism, delirium tremens, drug intoxication or reaction, and rabies. [Original Article]

今回は、aerophobia、hydrophobia...風水恐いと言えば、1956年以降国内で発症がない割に、巷に知られ、恐れられている病気。