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Case 29 

Case 29
Chapter:
Case 29
Author(s):

Joel David

, Anne Miller

, Anushka Soni

, and Lyn Williamson

DOI:
10.1093/med/9780199587506.003.0029
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date: 23 October 2019

A 36-year-old previously fit green-keeper at a golf course was admitted to the infectious diseases unit with a 5-week history of puffy hands, weakness of the arms and legs, and fatigue. He was finding it difficult to stand from sitting and had episodes of night-time fever. There was no travel history. He owned a dog. There was no history of tick bites, no contact with other individuals with a similar history, no past medical history, and no relevant family history. He had been a smoker of 15 cigarettes a day since age 19 years. Specific enquiry excluded Raynaud’s syndrome, dryness of eyes or mouth, rashes, or difficulty in swallowing and there was no change in bowel habit.

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