backend/data/active_cases/8d24dac3.json

{
  "case_id": "8d24dac3",
  "case_data": {
    "patient": {
      "age": 22,
      "gender": "Male",
      "location": "Varanasi, Uttar Pradesh"
    },
    "chief_complaint": "High-grade fever with chills and body aches for 5 days",
    "initial_presentation": "A 22-year-old college student from Varanasi presents to the medicine OPD with high-grade intermittent fever with chills and rigors for 5 days, accompanied by severe headache and generalized body aches. He reports that the fever comes every alternate day with drenching sweats and he feels relatively well between episodes.",
    "vital_signs": {
      "bp": "110/70",
      "hr": 98,
      "rr": 20,
      "temp": 39.4,
      "spo2": 98
    },
    "stages": [
      {
        "stage": "history",
        "info": "Fever started 5 days ago \u2014 initially daily, now clearly occurring every 48 hours (tertian pattern). Each episode begins with intense chills and shivering lasting 30-60 minutes, followed by high fever (up to 104\u00b0F) for 4-6 hours, then profuse sweating with defervescence. He feels almost normal between febrile episodes. Associated severe frontal headache, myalgia, and mild nausea. No vomiting, diarrhea, cough, rash, or bleeding manifestations. No altered sensorium or seizures. He recently returned 10 days ago from a college trip to Jim Corbett National Park, Uttarakhand (forested area) where they stayed in tents for 4 days with minimal mosquito protection. No prior history of malaria. No significant past medical history. No drug allergies. Lives in a hostel in Varanasi. No history of similar illness in hostel roommates."
      },
      {
        "stage": "physical_exam",
        "info": "Patient appears acutely ill during febrile episode, flushed. No pallor (or mild pallor). No icterus. No rash, petechiae, or eschar. No lymphadenopathy. Abdomen: Spleen palpable 2 cm below left costal margin, soft, mildly tender. Liver not palpable. No ascites. Chest: Clear bilaterally. Cardiovascular: S1S2 normal, no murmur. CNS: Fully conscious, oriented, GCS 15/15. No neck stiffness. No focal neurological deficits. No pedal edema."
      },
      {
        "stage": "labs",
        "info": "CBC: Hb 12.8 g/dL, WBC 5,200/cumm (normal differential), Platelets 1,10,000/cumm (mild thrombocytopenia). Peripheral blood smear (Giemsa stained): Ring-form trophozoites and mature schizonts seen within enlarged RBCs with Sch\u00fcffner's stippling \u2014 morphology consistent with Plasmodium vivax. Parasite index: <1%. Rapid diagnostic test (RDT): Positive for P. vivax (pLDH positive for Pv, PfHRP2 negative). Blood glucose: 95 mg/dL. Creatinine: 0.9 mg/dL. Bilirubin: 1.6 mg/dL (mild indirect hyperbilirubinemia). LFT: AST 48 U/L, ALT 40 U/L (mildly raised). Dengue NS1 and IgM: Negative. Widal test: Negative. Urine routine: Normal."
      }
    ],
    "diagnosis": "Plasmodium vivax malaria (uncomplicated)",
    "differentials": [
      "Plasmodium falciparum malaria",
      "Dengue fever",
      "Enteric (typhoid) fever",
      "Scrub typhus",
      "Viral fever (influenza/other)"
    ],
    "learning_points": [
      "P. vivax characteristically produces tertian fever (every 48-hour cycle) with classic cold stage (rigors) \u2192 hot stage (high fever) \u2192 sweating stage pattern, and enlarged RBCs with Sch\u00fcffner's stippling on peripheral smear",
      "Treatment of uncomplicated P. vivax: Chloroquine (25 mg/kg over 3 days) PLUS Primaquine (0.25 mg/kg daily for 14 days) for radical cure to eliminate hepatic hypnozoites and prevent relapse; G6PD testing must be done before starting primaquine",
      "P. vivax is the most common species causing malaria in India (~50-60% of cases), particularly dominant in northern and central India, while P. falciparum predominates in eastern and northeastern states",
      "Travel history to forested/endemic areas is critical in any patient with acute febrile illness \u2014 peripheral smear (thick and thin) remains the gold standard for malaria diagnosis; RDTs are useful for rapid point-of-care diagnosis in field settings"
    ],
    "atypical_features": "This is a straightforward beginner case with a classic presentation of P. vivax malaria \u2014 tertian periodicity, clear travel history to an endemic forested area, splenomegaly, mild thrombocytopenia, and characteristic peripheral smear findings. The case is designed to test basic recognition of the malaria fever pattern and appropriate species identification on smear.",
    "specialty": "infectious",
    "difficulty": "beginner",
    "id": "8d24dac3"
  },
  "timestamp": "2026-02-15T09:00:35.218170"
}