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53-Year-old man with fever, malaise and dyspnoea
  1. Nancy Lutwak,
  2. Curt Dill
  1. Department of Emergency Medicine, VA New York Harbor Healthcare System, NYU School of Medicine, New York, USA
  1. Correspondence to Dr Nancy Lutwak, nancy.lutwak{at}

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The patient is a 53-year-old man with 2 weeks of fever, sore throat, malaise, intermittent vomiting and diarrhoea. He had developed dyspnoea 2 days prior to presentation to the emergency department. He denied rashes, cough, abdominal pain, insect bites and chest pain.

Figure 1

ECG of the patient.

The patient history is significant for coronary artery disease, hypertension, rheumatoid arthritis and hyperlipidaemia. The patient denied previous episodes of presyncope or syncope. Medications included amlodipine 5 mg daily.

The patient had travelled to Connecticut within 1 week of developing the febrile illness.

Physical examination revealed temperature …

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