A patient presents with dizziness, a 1.1 cm hand abrasion, fever, and a low white blood cell count. Urine culture shows <10,000 CFU of E. coli and wound culture shows <10,000 CFU of Staphylococcus spp. What is the most likely diagnosis?

• A. Viral hepatitis
• B. Bacterial sepsis
• C. Urinary tract infection
• D. Wound infection

Answer: (A)

Fever with a low white blood cell count often points toward a viral process rather than a bacterial one. Here, the wound and urine cultures show very low bacterial counts, which makes a true active bacterial infection unlikely as the source of fever. Bacterial wound infections or urinary tract infections typically produce higher bacterial burdens and clearer local signs. Leukopenia can occur with viral illnesses, and a viral hepatitis infection would fit a systemic illness with fever without evidence of a significant bacterial infection. Putting these pieces together, the pattern is most consistent with a viral hepatitis rather than bacterial sepsis or a localized bacterial infection.