13th August 2024

A 19-year-old student presents with a 7 day history of fevers, headache, neck stiffness, and fatigue

A 19-year-old student presents with a 7 day history of fevers, headache, neck stiffness, and fatigue. He has felt too unwell to go to his lectures or go hiking with his friends on the weekend as they usually do. He drinks 14 units of alcohol per week, smokes 2-3 cigarettes per week when he is out with friends and is not sexually active. On assessment, he has a fever of 38.0 degrees Celsius. His chest is clear and abdomen soft non-tender. He has palpable cervical lymphadenopathy. You notice bilateral facial droop and reduced facial movements on cranial nerve examination, as well as mild neck stiffness. On inspection of the skin, you find a circular rash on his right shin, which he thinks he got after being bitten by an insect.

What is the most likely diagnosis?

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