A Traveler's Fever

Roberta Capp, MD; Natan Noviski, MD


December 11, 2017

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 17-year-old male presents to the emergency department with a headache that has lasted for the past 2 days. The patient states that he returned to the United States 2 days ago after spending 3 weeks in Nigeria. According to the patient, he felt well when he initially arrived in the United States, but developed a severe headache soon after. The headache is constant and throbbing, lasts throughout the day, and is relieved with ibuprofen. He is experiencing subjective fevers and intermittent sweats, especially at night, but he has not taken his temperature.

Today, while preparing to board a plane, the patient developed a worsening headache, bilious emesis, palpitations, and sweats. He decided to delay his trip and has now presented to the local emergency department for further evaluation. The patient denies having any trauma, seizures, abdominal pain, stiff neck, or photophobia. He has no significant medical history, and his only medication use is the ibuprofen that he has taken over the past 2 days.


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