Hey folks, just a quick reminder that this episode is not meant to be used for medical advice,

just good old-fashioned education. All patient information has been modified to protect their

identity and the views expressed in our podcast do not necessarily reflect the opinion of our

employers. Tonight is part two.

Make sure to check out last week's terrific discussion.

So I have another interesting case for you.

Our patient, a 24-year-old previously healthy man, presented with 10 days of headache,

two days of nausea and vomiting, and one day of fever after

returning from a trip to the Philippines. He had spent three weeks in the Philippines and returned to

the U.S. 14 days ago. Four days after returning, he developed bi-temporal headache with neck

stiffness after waking up from a nap.

He denied blurred vision and photophobia.

He initially thought his head and neck pain were due to sleeping in an awkward position.

He had some improvement in his neck stiffness and headache with massage therapy.

He had difficulty falling asleep given the severity of his headache.

Two days prior to arrival to the hospital, he developed nausea and experienced four episodes of non-bloody, non-billious vomiting,

and several episodes of non-bloody loose stools.

He developed subjective fevers one day prior to presentation.

He did not have dysmia, cough, abdominal pain, myalgia, arthralgia, or rash.

He did not receive pre-travel vaccination or prophylactic medications.

He lived the majority of his life in the Philippines and had moved to Northeastern U.S. 10 years ago to pursue undergraduate education.

He returned annually to the Philippines without ever becoming ill.

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