Case 21-1985

Abstract

Presentation of Case A 21-year-old man was admitted to the hospital because of lower-extremity weakness and urinary retention. Three months earlier he traveled to Kenya to study and used malarial prophylactic medication in the form of chloroquine and pyrimethamine–sulfadoxine (Fansidar) weekly. One month later he swam in a slow-moving stream in the Machakos district of Kenya with five fellow students and noted no subsequent rash or pruritus. All six were subsequently treated at a hospital in Nairobi because of diarrhea and fever. A diagnosis of malaria was considered likely but was not proved. Nearly four weeks later the patient experienced . . .