ABSTRACT
A 61-year-old man presented to the emergency department complaining of a 2-week history of fevers, a dry cough and diarrhoea. He was experiencing episodes of shivering every 3–4 hours. The diarrhoea was described as watery brown stool with no blood or mucus. He had returned from Thailand 24 hours ago, where he had been for the preceding 4 weeks. He travelled to Thailand annually for holidays. On this occasion he had stayed in a hotel on the coast, had been eating street food and reported at least one episode of unprotected sexual intercourse with a female sex worker from Thailand. He had become intoxicated with alcohol and had fallen over in the street 3 weeks earlier, sustaining multiple lacerations to his legs. His past history included hypertension and peripheral vascular disease. He had received his UK childhood vaccine schedule with tetanus boosters, as well as immunisations for hepatitis A and typhoid immunisation prior to travel. He took an unspecified antihypertensive agent once daily. He worked as a pub landlord and was a current smoker with a 60 pack year history. He drank alcohol to excess but denied recreational drug use.
