A 45-year-old man presents to the Emergency Department with a fever, widespread rash, and confusion. His only past history of note was Sydenham's chorea and a number of recent
dental extractions.
While in hospital, his rash, which initially looked like petechial haemorrhages, worsens and
develops into a purpuric rash heavily concentrated on his trunk and lower limbs. He is started
on cefuroxime and aciclovir. Over the weekend, he develops an episode of ataxic hemiparesis
that resolves. When he is seen on the Monday morning ward round, he complains of
incoordination of his right arm.
A computed tomography head shows evidence of small infarcts in a number of areas. A
lumbar puncture is performed. The only abnormality is a raised protein of 0.7 g/l (normal

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