Affiliation:
1. National University Health System, Singapore
2. National Centre for Infectious Diseases, Singapore
3. National University Hospital, Singapore
4. National University of Singapore, Singapore
Abstract
We outline a case of a 59-year-old Malaysian man of Indian origin with no known past medical history apart from diabetes mellitus and hypertension, who presented with a 7-day history of unrelenting fever, myalgia, confusion and unsteady gait. He worked as a shipyard engineer and travelled between Singapore and Ipoh, Malaysia. In Ipoh, he lived in a village with domesticated cows and would frequently drink cow urine as part of his religious and cultural practice. His last travel to Ipoh had been approximately 2 weeks prior to presentation. At presentation, he was febrile (39 °C), with a blood pressure of 100/82 mmHg, and narrowed pulse pressure. He had an unsteady gait, but did not have any other physical signs of cerebellar dysfunction or neurological deficits.
Publisher
Academy of Medicine, Singapore