Author: Natasha Dole / Editor: Thomas MacMahon / Reviewer: Ffyon Davies / Codes: EnC1, ResC1, SLO1Published: 11/03/2023

A 67-year-old lady presents to the Emergency Department (ED) with mild wheeze, frontal headache, fever and vomiting. Her symptoms started four days ago, shortly after finishing a self-prescribed course of prednisolone for an asthma exacerbation.

She describes the headache as constant and throbbing with a pain severity of 6 out of 10. She also reports abdominal pain, lethargy, low mood and recent fever.

She is recently retired with a background history of well controlled hypertension. She frequently self-treats asthma exacerbations with oral steroids sourced abroad.

Clinical examination reveals scattered wheeze throughout her lung fields with isolated fine crackles. The remainder of her examination was unremarkable. Her blood pressure was 90/60 mmHg, heart rate 120bpm, temperature 38oC, respiratory rate 22 and oxygen saturations on room air of 94%.

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