Authors: Matthew Schofield, Graham Johnson / Editor: Andrew Tabner / Reviewer: Graham Johnson / Codes: EC14, IC5, SLO1Published: 07/05/2021

A 34-year-old male, previously fit and well, presents to the emergency department with general malaise and increasing myalgia for two weeks since returning from a stag do abroad. He is from outside the region attending a wedding and has a 48-hour history of bilateral neck swelling. He is complaining of a dull headache with increasing pain in his right ear associated with muffled hearing. He tells you his ankles have started to ache but puts this down to his new shoes he has worn for the wedding.

He denies any past medical history and takes no regular medications. He works full time as a banker.

On examination he appears anxious and flushed and has bilateral neck/face swellings as illustrated in the image below. He has a temperature of 40.7 degrees, is tachycardic at 120bpm and clammy to touch.

His ECG shows sinus tachycardia

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