A 47-year-old Tongan male returning to New Zealand after a 2-week holiday in Tonga presented with 3 days of progressive limb weakness, numbness, unsteady gait, and dyspnea. Two days before departing Tonga (6 days before neurologic symptoms), he developed leg swelling with erythematous and pustular lesions, which were treated with flucloxacillin. He had no medical history, was not taking regular medication, and had a 20 pack-year smoking history.
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Siu et al. (2016) studied this question.
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