His blood glucose was 116 milligrams per deciliter (mg/dL) (90–120 mg/dL). He went to the military medical clinic two days prior to ED presentation where he was diagnosed with a complex migraine and discharged to the barracks on quarters (strict bed rest) with ibuprofen and ondansetron and instructions to return for follow-up the next day to evaluate for resolution of symptoms.ĭuring the subsequent ED visit his vital signs included a heart rate of 113 beats per minute, blood pressure 117/76 millimeters of mercury, respiration 16 breaths per minute, and temperature 98.5 degrees Fahrenheit.
He reported progressive neurologic signs and symptoms including being unable to close his eyes or mouth, which made sleeping and eating difficult, as well as right-sided facial numbness.
He began experiencing mild paresthesia in his hands and feet four days prior to ED presentation. A resident of Puerto Rico, the patient had recently traveled to San Antonio, Texas, for military exercises and received multiple vaccines five days prior to onset of symptoms. A 27-year-old male military recruit without significant previous medical history was transported to the emergency department (ED) by ambulance with a chief complaint of bilateral facial paralysis.
