Case 22-2002

Presentation of Case A 37-year-old man was admitted to the hospital because of three weeks of intermittent fever and abdominal and back pain. The patient had been well until about seven months earlier, one month after he had begun a difficult trip by land from his native Peru to the United States. During his trip, which took four months, he ate fruit directly from trees, bathed in and drank water from rivers and other uncertain sources, passed through several tropical rain forests, and received numerous mosquito bites. In Guatemala, about 7 months before admission, he had a fever that lasted . . .