A Fall in Ghana

Presentation
A fall marked the beginning of a perilous medical journey for a 34-year-old man. He had traveled from the United States, where he lives with his family, to Accra, Ghana for business purposes and was well until the ninth day of his trip, when he fell and twisted his lower back. Although he was able to stand immediately afterwards, the back pain worsened as the morning progressed and was then compounded by malaise, leading him to spend the remainder of the day in bed. He had no neurologic deficits or loss of bowel or bladder continence.

That evening, the patient developed a fever of 102.1° F (38.9° C) with chills and progressive malaise. His health status began to rapidly deteriorate, and he was evacuated to the United States the following day. En route he developed hypoxia, which was corrected with supplemental oxygen. Tachycardia and hypotension responded to intravenous fluid. Upon arrival, he was evaluated at a community hospital, where he received empiric ceftriaxone. He was determined to be in critical condition and was transferred urgently to the intensive care unit (ICU) of the National Naval Medical Center in Bethesda, Md for further management.

Previously healthy, the patient had an unremarkable medical history. A systems review revealed no further complaints, and he had been fully compliant with his malaria prophylaxis. Throughout his stay in Ghana, he had no contact with sick people, animal exposure, or insect bites. He did not leave the luxury hotel complex and only ate approved prepared meals, except for 1 dinner on day 3, which took place at a high-end restaurant with colleagues. His vaccinations were current.

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-- Michael Eberlein, MD, PhD, Mayy F. Chahla, MD, Sammy A. Baierlein, MD, Richard T. Mahon, MD

This article was originally published in the December 2009 issue of The American Journal of Medicine.