31-Year-Old South African Man With Fever and Headache

Abstract

A 31-year-old man with no medical history presented to the emergency department (ED) with a 1-week history of worsening headaches, myalgia, and high-grade fever. He had arrived in Minnesota from South Africa a few days before onset of symptoms to work on a local farm. In South Africa, he worked near Durban as a farmer tending sheep and cattle in open fields. He complained of diffuse body aches, mild headache, chills, and subjective fevers. He sought an evaluation at a local urgent care center 2 days after the onset of symptoms, where basic blood work was notable only for an elevated C-reactive protein level at 65.3 mg/L (reference range, <5.0 mg/L). He was given a course of amoxicillin and a tetanus shot. The patient was not taking any other daily medications. A blood smear was negative for malaria. While taking the antibiotics, his symptoms progressed with worsening headache and photophobia. He reported having multiple previous tick and mosquito bites, as well as animal exposures because of his work on the farm. Before leaving South Africa, he had felt well and had no known sick contacts. He was married and reported no recent new sexual contacts. He was unsure of his immunization status.He presented to the ED on day 7 of the current illness because of worsening symptoms. He underwent computed tomography of the head, lumbar puncture, and basic laboratory work-up and was initiated on treatment for meningitis before being admitted to the hospital.