ABSTRACT
A 19-year-old medical student has been brought to the emergency department by his flatmates who are concerned that he has become progressively unwell over a period of 5 days. He initially had symptoms of a mild coryzal illness, with a sore throat, headache and cough. For the past 72 hours he has been intermittently febrile, complaining of right-sided earache and deafness, and nausea. His sore throat is worsening and he feels as though his ‘glands are up’. He describes being unable to swallow food or fluids. He has no medical history and did not experience any significant childhood illnesses, although he did not receive all his normal childhood vaccinations owing to parental concerns regarding immunizations.
