A 23-year-old man presented with a 5-day history of headache and photophobia, and 3 days history of fever and vomiting. The headache was predominantly frontal, and refractory to simple analgesia. The vomiting was not associated with any precipitant, and had occurred approximately 4 times per day since its onset.
Admission bloods revealed a leukopenia (a combined neutropenia, lymphopenia and monocytopenia, but with a relative lymphocytosis) and a normal C-reactive protein level.
He underwent a lumbar puncture. The findings are below:
Question 2. Based on the history, examination and the above results, what is the most likely diagnosis?
Mumps virus is a single-stranded negative sense RNA virus belonging to the Paramyxovirus group. There is only a single serotype. The incidence of mumps peaks around school age, and respiratory droplets, direct contact and fomites spread the virus. Peak viral shedding occurs in the days just prior to the onset of symptoms. It is highly contagious and spreads quickly amongst susceptible people living in close quarters.
Mumps infection is characterized by a prodrome of low-grade fever, myalgias, anorexia, and headache, followed 1-2 days later by parotitis (in 95% of symptomatic cases), which is the hallmark of the condition. The parotid swelling lasts for approximately a week, and is almost always ultimately bilateral, although there may be a delay of several days before the contralateral parotid gland becomes inflamed.
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