ABSTRACT
A 22-year-old woman presented to hospital complaining of a 2-week history of fever, shivers and malaise. She had visited her general practitioner several times in the past fortnight, who had initially suspected that she had influenza. She had been experiencing intermittent frontal headaches associated with episodes of nausea. The patient denied any vomiting but had suffered from a constant, dull ache in the upper abdomen over the last few days. She had not experienced diarrhoea and could not recall opening her bowels during the preceding week. There were no symptoms of photophobia, neck stiffness or cough. She was normally fit and well with no past medical problems. She took no regular medications aside from a course of proguanil hydrochloride with atovaquone (anti-malarial prophylaxis) that she had recently completed. She lived with her husband and 14-month-old son, whom she was breastfeeding at the time of presentation. She had never smoked and did not drink alcohol. The patient and her family had returned 3 weeks earlier from a holiday in Ghana, where they had stayed for 2 weeks. They spent most of their holiday in Accra, but had travelled to rural areas for 3–4 days to visit relatives. Her husband had been well, but her son developed symptoms of fever and diarrhoea toward the end of the holiday. He had recovered fully and did not require any medical intervention. She had otherwise remained in the United Kingdom for the last 2 years, although she had lived in Ghana until she was 18 years old. The patient stated that her husband was her only sexual contact.
