ID Fellows Cup Question 8

C is a 16-year-old who presents to the emergency department with fevers and generalized weakness. He fell horseback riding about 2 weeks prior and suffered an open fracture of his left forearm. He was treated at a local ED and has external fixation device in place. Over the last several days he has developed redness over forearm as well as low grade fevers. He has also noticed some difficulty with swallowing and symmetric weakness that is fairly generalized but has begun limiting activities. He presented today after experiencing double vision which has progressed to become more blurred. Pupils are pictured.

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