A 48-year-old woman presented to the ED with headache, nausea, and fever of 2-day duration. She denied any other symptoms, except for some vague malaise and fatigue for several weeks prior to presentation. She denied dyspnea, cough, chest pain, rash, joint swelling, and bruising.
Her past medical history was significant for migraine headaches, gastroesophageal reflux disease, and three uneventful pregnancies. Her family history was unremarkable; she did not smoke cigarettes or use illicit drugs, and she drank alcohol occasionally. She was visiting Arizona from a mid-south state.