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.