A 65-year-old man with a history of binge drinking who had engaged in gardening was brought to our hospital for lethargy. On physical examination, temperature was 35.0 °C, blood pressure was 70/50 mmHg, pulse was 64/minute, respiratory rate was 30/minute and oxygen saturation was 97 % while breathing from a 10 L oxygen mask. He appeared disheveled, and his consciousness level was E4V2M1 on the Glasgow Coma Scale. He had trismus with an oral aperture of only one finger breadth (Fig. 1A) and neck stiffness.
