a 49-year-old, male, from Ubon Ratchathani, a farmer for 30 years with no history of major illnesses or previous hospitalizations, no history of trauma. No known allergy to food and drugs, nor exposure to toxic chemicals. His mother and a sister had diabetes mellitus. His illness started 3 weeks prior to admission as pain, swelling, and limitation of movement of the left shoulder, with intermittent, moderate to high grade fever. Consultation was done with a private doctor where he was given unrecalled medications, which afforded no relief of symptoms. One day prior to admission, he had 10 episodes of loose bowel movement, which were watery, non-mucoid, non-blood streaked, moderate in amounts. He complained of generalized musculoskeletal pain, nausea and headache. Relatives rush him to a hospital. The patient is a 30 pack-year smoker and an occasional alcoholic drinker.