A 20-year-old man with fever, headache, and neck stiffness. Neuroborreliosis with tick-borne relapsing fever.

摘要

A 20-year-old white college student, with no significant medical history, presented to the emergency department in March 2009 with symptoms of fever, headache, neck stiffness, and vomiting for 3 days. Four days before evaluation, he had noticed an ery-thematous maculopapular skin rash over the right antecubital fossa. Over the course of next 3 days, he had developed worsening occipital headache associated with vomiting, neck stiffness, photophobia, fever, and myalgia, which prompted him to seek care.Twelve days before his visit to the emergency department, the patient had traveled by car through California.