26th August 2024

A 44-year-old man who arrived in the UK 4 days ago after travelling from Afghanistan

A 44-year-old man who arrived in the UK 4 days ago after travelling from Afghanistan presents with muscle pain and weakness which has developed over the last 2 days.  During his journey, he had what he describes as a flu-like illness with a fever, headache, neck stiffness and photophobia, but the symptoms resolved without treatment. He has no other known medical history and takes no medications.

On examination, he is weak throughout both upper and lower limbs, though more marked in the legs and in the proximal muscles. You note that his left leg appears to be more affected than his right. He is asymmetrically hypotonic, and you are unable to elicit reflexes. Sensory examination is normal. The translator notes that he is mildly dysarthric and you note that he seems to be having difficulty managing and swallowing oral secretions.

A CT head performed in A&E shows no cause for his symptoms. An MRI of his head and spine identifies no cause for his symptoms. CSF analysis shows a high white cell count (167 cells/mm³) which is predominantly lymphocytes, and his protein level is elevated (45 mg/100ml). CSF culture is not yet back.

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