title: Clinical Case of the Month: A 49-Year-Old Man with Fever, Headache and Leg Weakness.
abstract: A 49-year-old man with an unremarkable past medical history presented to an outside hospital with a five-day history of fever, left leg weakness, myalgia and headache. The patient reported that the illness started as a fever and sore throat and he was originally diagnosed with streptococcal pharyngitis and prescribed antibiotics. The day after his initial diagnosis, his fever had progressed to include a headache, myalgia, a rash on his upper torso and right shoulder and sudden-onset left leg weakness with preserved sensation. With progressively worsening symptoms, he eventually presented to a local emergency department (ED), five days after his symptoms first started. He was experiencing continued left leg weakness, an inability to ambulate, persistent fevers to 103ºF, muscle aches, an intense band-like headache and confusion. The patient denied neck stiffness, photophobia, loss of sensation or any additional muscle weakness. He denied any recent travel aside from work, any sick contacts, recent tick/insect bites, history of sexually transmitted diseases or contact with animals. He reported no history of illicit drug use as well as no recent weight loss, trauma or radiation exposure. The patient had approximately a 10-pack-year tobacco smoking history. For the last ten years he drank about a six-pack of beer daily while onshore (roughly two weeks out of every month). He works on an offshore oil platform. He was not taking any home medications besides his recently prescribed antibiotics. He lived alone at home in a moderately rural area of South Louisiana. His family history was non-contributory.
authors.affiliation: Dr. Cardinale is a first-year House Officer in the Department of Anesthesiology at Ochsner Medical Center, New Orleans, LA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Cardinale
authors.affiliation: O. Gentile is a third-year medical student at Tulane University School of Medicine, New Orleans, LA.
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Gentile
authors.affiliation: L. Reddy is a third-year medical student at the University of Queensland-Ochsner Clinical School, New Orleans, LA.
authors.forename: Laya M
authors.initials: LM
authors.lastname: Reddy
authors.affiliation: Dr. Tran is a second-year House Officer in the Department of Internal Medicine at Ochsner Medical Center, New Orleans, LA.
authors.forename: Trung N
authors.initials: TN
authors.lastname: Tran
authors.affiliation: Dr. Avalos is Ochsner Core Faculty and a Staff member within the Department of Internal Medicine at Ochsner Medical Center, New Orleans, LA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Avalos
authors.affiliation: Dr. Lopez is the Richard Vial Professor and Vice Chair in the Department of Medicine at LSU-Health Sciences Center in New Orleans, LA.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Lopez
mesh_terms: D005334:Fever; D006261:Headache; D006801:Humans; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness