A marathon runner with a change in mental status

Abstract

A 45-year-old previously healthy man presented in the late spring to the emergency department with complaints of 2 months of weight loss (47 lb) leading to a 25% weight reduction, fevers, night sweats, chills, a dry cough, and confusion for 3 days. Seven weeks earlier, he had noted the onset of a rash starting on the palms and soles and later on the dorsal surfaces of his hands and feet, transiently on his back. Most recently, in the previous 3 weeks, he also noted a rash on the nose and surrounding his mouth. For 5 weeks, he had diarrhea. Three months before presentation, he traveled to New Orleans and Sacramento, California for work-related meetings. He worked as a lawyer and was a marathon runner.