Last week, a Perth-based GP shared a case of a patient with muscle pain and robotic voice. See what other GPs suggested, and what was the final diagnosis.
Challenge
Last week, you saw the diagnostic challenge of a 60-year-old man presenting with a 1 week history of muscle pains after returning to Great Southern WA from a 4-week holiday in coastal NSW. The patient also has rashes, muscle weakness and a self-detected robotic voice.
Based on the details from challenge, one GP suggested that syphilis (the great imitator) could be an explanation for these symptoms. Another GP suggested that the symptoms matched a case of tick paralysis from Ixodes holocyclus, also known as the Australian paralysis tick.
The final diagnosis
According to Dr Hector Faulkner, a GP based in Denmark, WA, who provided this mystery case, the patient suffered from Guillian Barre secondary to Q Fever. The patient also had a case of herpes simplex and was treated with intragam infusion and doxycycline.
Some advice from Dr Faulkner:
“Always ask about the occupational and travel history and the weirder the presentation the further back you go in the history. He had no history of overseas travel, which excludes Lyme disease and a few others like malaria (another great imitator). He had been in NSW for 4 weeks but the 4 weeks prior to that he had been on a Northwest WA cattle station dragging dead cattle around and burning them! Beware of the patient with a robotic voice even if it’s in his head – it can be an early cranial nerve weakness.”
Please send your answers, ideas or suggestions to: karl@mforum.com.au. All GPs are welcome to share their odd cases.