Author: Susan Uí Bhroin / Editor: Sarah Edwards / Codes: ObP6, RP7, SLO3 / Published: 12/08/2021

An 18-year-old female student is brought in by ambulance after her flatmates found her unwell at home at 11am. They tell you she was fine the previous night before bed but this morning is drowsy, has a rash and feels very hot when they touch her. They don’t think she has any medical history or allergies. One of them tells you that the patient couldn’t be pregnant because she asked her flatmate for a tampon previous morning.

From the end of the bed you can see she has a diffuse erythematous rash resembling sunburn. Her blood pressure is 80/50, heart rate 130 BPM (sinus tachycardia on ECG), SpO2 96% on room air. She is drowsy and confused but can tell you she has a headache and feels cold. Her temperature is 39.2C.

Apart from the rash, her physical examination is unremarkable.

She has ongoing diarrhoea and when the nurses change her into a gown, one of them notices a tampon string.

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