- An 80-year-old man presented to the emergency department with exertional dyspnea. His symptoms had begun 3 weeks prior to presentation and had progressively worsened. Additional review of systems elicited nonexertional chest pain, orthopnea, hemoptysis, and epistaxis. He reported no fever, chills, headaches, night sweats, weight changes, sputum production, abdominal pain, nausea, vomiting, or obstructive voiding symptoms. He lived in southeastern Minnesota and had no recent travel history. Forty years previously, he had discontinued his habits of smoking, drinking alcohol, and consuming illegal drugs.
- A 30-year-old woman presented for the evaluation of acute cough in March 2020. Over the previous 4 days, she had experienced cough, dyspnea, and post-tussive emesis. Within the previous 3 days, she had developed diffuse myalgia and anosmia. She requested a telehealth visit with her primary physician due to progression of her symptoms.
- A 41-year-old man came to the emergency department with several days of bloody diarrhea. His symptoms began 3 days prior with worsening lower abdominal cramping and fecal urgency. This progressed to frank bloody diarrhea with a bowel movement every 1 to 3 hours. He had taken his temperature at home, with a maximum of 100.4°F that resolved within minutes without intervention. He had had no chills, night sweats, or weight changes. He lived in Southeast Minnesota and denied recent antibiotic use, travel, and sick contacts.
- A 33-year-old man presented to our medical center with 3 months of nonproductive cough, anorexia, fatigue, night sweats, and a 6.8 kg weight loss. The patient's symptoms began on a deer hunting trip in the fall in northern Minnesota, when he reclined on a patch of earth that he had cleared of copious organic matter. Immediately on returning from his trip, he was fatigued and slept 18 hours per day. One week later he developed night sweats, anorexia, and nonproductive cough, prompting a visit to his primary care physician.
- A 58-year-old man presented to his primary care physician with subjective fevers of 4 days' duration. His physician diagnosed a viral syndrome and prescribed acetaminophen. One day later, the patient returned complaining of acute-onset right eye pain, blurred vision, confusion, and pain in the left great toe. He did not wear contact lenses and had had no eye injury, headache, recent dental work, or symptoms involving the gastrointestinal or genitourinary tract. His peripheral leukocyte count was elevated to 19 × 109/L (reference range, 3.5-10.5 × 109/L).
- A 36-year-old farmer presented to his primary care physician for evaluation of cough with white sputum, pleuritic chest pain, and chills with rigors (maximum temperature, 38.9°C), all of 1 day's duration. While traveling to his local clinic, the patient also developed acute bilateral eye pain with redness, swelling, and discharge. His medical history was notable only for a fractured jaw. He had a 24-pack-year history of smoking and had previously used methamphetamine. He was taking no medications or illegal drugs.