Presentation.

A 45-year-old man presents with a three-week history of severe muscle pain and intermittent fevers. Initially, the pain was generalized, but over the past few days, it has become so intense that even turning in bed is excruciating. He now reports that moving his tongue is painful, making it difficult to eat and speak.

He also complains of a persistent dry cough and a skin rash developed over the last two weeks.

Examination.

• He appears fatigued and in significant discomfort.
• His eyes are red with small hemorrhages, and his eyelids are swollen.
• There is severe muscle tenderness, including in the jaw and tongue muscles.
• Occasional crepitations are heard in the lungs, but the rest of the systemic examination is unremarkable.

History:

Three weeks ago, the patient had been on an outdoor camping trip in a rural area with friends. They spent several nights in the wilderness, hiking, fishing, and preparing meals over an open fire. One evening, they cooked and ate a meal of wild pork, roasted corn, and freshly picked wild fruits.

A few days after returning home, he developed generalized body aches and fever, which he initially thought was due to exhaustion. However, the symptoms worsened over time, with increasing muscle pain, persistent fever, and a strange rash. Now, he finds it painful to move his tongue, making speaking and eating difficult.