2nd August 2023

A 35-year-old man presents with confusion and drowsiness. He has recently suffered from daytime somnolence

A 35-year-old man presents with confusion and drowsiness. He has recently suffered from daytime somnolence, poor sleep, and generalised weakness. Before the onset of symptoms, he had been feeling feverish for about a week and felt like his “neck glands were swollen”. His wife also shows you a picture of what appears to be a chancre on the dorsum of his left hand, which appeared after he returned from Kenya 4weeks ago. However, on examination today, the lesion has healed.

What is the most likely diagnosis?

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