Grigor Dimitrov came out strong but faded fast as the Winston-Salem Open's top seed was forced to retire from his match against Dominic Thiem, sending the Austrian into the round of 16.
With less than a week to go before the start of the US Open, Dimitrov came out sharp, unleashing a torrent of backhanded slices to keep Thiem off balance as the Bulgarian raced through the surprisingly one-sided first set 6-0.
But things took a turn for the worse for Dimitrov at 2-2 in the second and he began to misfire in bunches in an apparent attempt to shorten points.
After a visit from medical staff, he stepped up to the line to serve while trailing 2-4 but decided he was feeling too unwell to continue and shook hands at the net, where he waited for Thiem while hunched over.
The win gives another lifeline to 2020 US Open champion Thiem, who had to save two match points to win his rain-delayed opener against American J.J. Wolf the day before.
Thiem will next face either Italy's Fabio Fognini or Britain's Jack Draper.
Earlier in the day, France's Benjamin Bonzi, Australia's Jason Kubler and Americans Maxime Cressy and Steve Johnson were among those who advanced in straight sets at the ATP 250 tournament in North Carolina.
Captain Marquinhos has snatched the winner as champions Paris St Germain won 2-1 at troubled Olympique de Marseille in Ligue 1 on Sunday, condemning the hosts to a fifth successive loss and a spot in the relegation zone.
Manchester City head into the first international break three points clear at the top of the Premier League after Antoine Semenyo's double sealed an enthralling 5-3 home win over Sunderland, for whom Brian Brobbey grabbed a hat-trick, on Sunday.
JJ Spaun had a message for US Presidents Cup captain Brandt Snedeker, and he delivered it with his clubs instead of his phone, closing with a hot finish to win the BMW PGA Championship on Sunday in Surrey, England.
Atletico Madrid beat arch-rivals Real Madrid 2-1 in LaLiga on Sunday as second-half goals from Alejandro Grimaldo and Jonathan David settled a tense derby at a packed Estadio Metropolitano.
UAE athletes competed in shooting, cycling, triathlon, swimming and football at the Asian Games in Japan on Sunday, as the country's campaign continued across Aichi-Nagoya.
The UAE, working with Paraguay, has sent humanitarian supplies to communities affected by the earthquake in Colombia as part of a $10 million aid package.
The UAE has called for a more inclusive international approach to combating extremism and hate speech, with greater involvement from community leaders, young people, civil society and technology companies.