Clinical Reasoning: A 29-Year-Old Man With Fevers and Rapidly Progressive Cranial Neuropathies

A 29-year-old man with no prior known medical diagnoses presented to the emergency department with 5 days of fevers, chills, vomiting, headache, and neck pain followed by voice changes, difficulty swallowing, and intractable hiccups. The patient denied vision changes, weakness, numbness, recent travel, new medications, or illicit drug use. He had no personal or family history of neurologic illness. On questioning concerning possible toxic exposure, he noted recent consumption of sushi and raw meat at a restaurant; a friend who had eaten with him also experienced gastrointestinal illness after that meal.

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