Abstract
A 36-year-old white man with a 20 pack-year smoking history, childhood asthma, and previous heavy alcohol use presented with progressive dyspnea on exertion and chest tightness for the past month. He lived in the Los Angeles area, but frequently hiked in the Southern California area, including twice in the past year around Bakersfield, and after one trip about 9 months prior, noted a febrile illness that he felt may have been related to an insect bite. He was seen in our Emergency Department with a low-grade fever (T = 38.06°C [100.5°F], tachycardia to 142 beats per minute) and sharp right-sided head pain.
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