PathWays Case Study: January 26

A 37-year-old woman was seen in an outpatient clinic for a cyclic fever of two-days duration, headaches, and myalgias. She reported having similar symptoms that lasted for 8 days prior to this episode. There is no relevant past medical history. Recent travel history includes: a week-long backpacking trip in Colorado (3 weeks ago), a 2-week trip to Hawaii (3 months ago), and a 5-day trip to South Africa (5 months ago).




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Andrew Norgan, M.D., Ph.D.

Andrew Norgan, M.D., Ph.D.
Resident, Anatomic/Clinical Pathology Fellowship
Mayo Clinic




Dr. Bobbi Pritt

Bobbi Pritt, M.D.
Vice Chair of Education, Department of Laboratory Medicine
Consultant, Division of Clinical Microbiology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine


April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.


Another excellent case. Thanks very much.

Thanks a lot for such a great case:-)

Interesting Case.
Answer is Borrelia spp.

Good case correct answer

Serum sickness – a lymphocyte or a macrophage attacking the bacteria

An excellent case of differential diagnosis, with emphasis on geographical considerations while the diagnosis of a disease is sought. Thanks for enlightening.

Excellent piece of information.

Thanks for discussing this excellent case. Good and tough choices. Makes us think

very interesting

Thank you for continuing my interest in morphologic pathology. It began in 1953 @ Pitt Med school and continued until 2010 as a Pathologist with morphologic duties at the Presbyterian-Univ Hospital in Pittsburgh, PA, now termed UPMC. As you understand morphology goes better with added History of the patient.

Dr. Norgan: Great case, Keep ’em coming !

good case

This was a great case!

I love it when “low tech” methods yield totally unexpected diagnoses! Great case — many thanks to Drs. Norgan and Pritt!

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