ABSTRACT
A 56-year-old man was admitted to the emergency department complaining of a 1-month history of worsening headaches, fevers, lethargy, cough and rigors. He had been deteriorating over recent weeks and had been persuaded by family members to attend hospital. He denied any weight loss or night sweats. His past history was significant for hypertension and recently diagnosed type 2 diabetes mellitus, which was diet controlled. His only prescribed medication was 2.5 mg ramipril OD, although the patient admitted that he did not take this. He was from Nigeria originally and had moved to London 3 years earlier. He visited Nigeria every summer, with his last trip being 9 months earlier, but had not travelled abroad otherwise. He had no unwell close contacts. He had never smoked and did not drink alcohol.
