Case Presentation
An 18-year-old Caucasian male with a past medical history of infectious mononucleosis eight weeks ago presented with altered mental status. His friends found him lying on the floor with a fever, groaning, combative, and not able to be calmed with verbal measures. He was alert and oriented as recently as the day prior. Emergency medical services (EMS) brought him to an outside facility, where he was sedated and intubated to protect his airway and transferred to our facility. Physical examination demonstrated a fever of 39.16 ℃ (102.5℉), no lymphadenopathy, mild hepatosplenomegaly, and nuchal rigidity. Initial neurological examination under sedation was otherwise non-focal.