13th August 2024

A 52-year-old man presents to A&E with headache, fevers, reduced appetite and muscle aches

A 52-year-old man presents to A&E with headache, fevers, reduced appetite and muscle aches. He reports these symptoms have been worsening over the last 3 days. On assessment, his HR is 107 bpm, BP 110/65 mmHg, temperature 38.1 degrees Celsius, RR 21/minute, oxygen saturations 95%. There is no lymphadenopathy, neck stiffness or skin changes. He does appear slightly jaundiced. He has no cough, dysuria or vomiting.  He tells you that he returned from Nigeria around 5 weeks ago where he was visiting family. He did not take malaria prophylaxis whilst he was there. He is sexually active with a regular partner and had a normal sexual health screen 3 weeks ago. None of his close contacts have been unwell recently. He is usually well and works as a gym instructor.

Initial investigations are as follows:

Results from a lumbar puncture, blood films and HIV test are pending.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.