ABSTRACT
A 27-year-old man presented to the emergency department complaining of a 5-day history of fevers and myalgia. He described profound lethargy, feeling unable to get out of bed, for the preceding 24 hours and had experienced several episodes of diarrhoea and vomiting. He had developed a headache and photophobia earlier that morning and thought that his urine looked much darker than it usually did. He had delayed presenting to hospital as he stated that he had recently had unprotected sexual intercourse (UPSI) and was concerned that he may be told that he had contracted HIV. His past medical history included childhood measles. He took no regular medications. He worked as a canoe instructor and lived alone. He did not drink alcohol and had never smoked. He had not travelled outside of the United Kingdom for at least 2 years.
