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February 1, 1965

Plague Meningitis in an American Serviceman

JAMA. 1965;191(5):412-413. doi:10.1001/jama.1965.03080050058021

PLAGUE is an endemic disease in Southeast Asia and when large numbers of US personnel entered the area, measures were taken to protect them from infection. These proved highly effective, but in the case recorded here bubonic plague masqueraded as venereal infection and remained unrecognized until the development of the rare complication of plague meningitis.

Report of a Case  A 23-year-old white male, serving with American military advisors in Viet Nam, was seen in a dispensary on March 21, 1963, with swelling in the left inguinal region, associated with fever, pain, and tenderness. The examining physician noted a questionable penile lesion and made a diagnosis of lymphogranuloma venereum. The patient was treated orally with tetracycline, but the inguinal swelling increased, accompanied by marked edema and erythema. This was interpreted as cellulitis and 2.4 million units daily of procaine penicillin G was given intramuscularly with the tetracycline. On March 23 the

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