History of presentation
A 64-year-old male presented to the emergency department with a 1-day
history of fever and chills associated with headache and intermittent
episodes of confusion. Vitals were significant for temperature of 102 F,
blood pressure 140/74 mm Hg, pulse rate of 92/min and respiratory rate
22/min. Physical examination showed an ill-appearing male, alert, and
oriented with supple neck and no focal neurologic deficits. Rest of the
systemic examination was unremarkable.
ECG showed normal sinus rhythm.
Chest X-ray showed no focal consolidation. CT head without contrast
showed no evidence of intracranial hemorrhage, mass effect or acute
territorial infarct. CT abdomen and pelvis without contrast showed
thickening of distal esophagus concerning for esophagitis.