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.
Women's top seed Aryna Sabalenka was knocked out in the fourth round of Wimbledon by an inspired Naomi Osaka on Sunday with the Japanese player blazing to a 6-2 7-6(2) win on Centre Court.
Novak Djokovic added another chapter to his Wimbledon legacy on Sunday as the Serb fought past Russian qualifier Roman Safiullin 7-6(6) 6-3 3-6 6-3 to earn a record 106th match victory at the All England Club and reach another quarter-final.
Ferrari's Charles Leclerc won a dramatic British Grand Prix under safety car conditions on Sunday as Mercedes's Kimi Antonelli failed to score for the second time in three races and saw his once-commanding Formula One lead slashed to 25 points.
Fourth seed Jessica Pegula's greater experience proved telling as she beat rising fellow American Iva Jovic 4-6 6-3 6-1 to equal her best Wimbledon run by reaching the quarter-finals for the second time on Sunday.
Kylian Mbappe converted a second-half penalty as France sweated through a suffocating Philadelphia furnace and wrestled their way out of a brutal scrap with Paraguay to snatch a 1-0 win on Saturday, setting up a World Cup quarter-final against Morocco.
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