Author: Jessie Lynch, John Ryan, Jeffrey Mulcaire / Editor: Steve Corry-Bass / Reviewer: Jessie Lynch / Codes: DP1, IP1, IP3, NepC1, RP6, SLO1, SLO3 / Published: 15/08/2023
A previously well 29-year-old male presents with a 3 day history of shortness of breath, pyrexia, abdominal pain, vomiting, diarrhoea, fatigue and general malaise. He sustained a laceration to his left elbow 1 week ago from a hockey pitch. He also had a large amount of alcohol and cocaine 4 days ago.
On examination he is febrile (39.1⁰C), tachycardic (120bpm) and tachypnoeic (RR27). He is drowsy and disoriented. He has a normal cardiorespiratory examination, and his abdomen is diffusely tender but soft. He has a laceration on his left elbow, with purulent exudate and surrounding erythema. He also has a widespread petechial rash.
His bloods are as follows:
- WBC 9.6×109/l (3.6-11.0×109/l)
- Neutrophils 9.1×109/l (1.5-7.5×109/l)
- Haemoglobin 138g/l (130-180g/l)
- Platelets 102×109/l (140-400×109/l)
- CK 610 (40-320U/L)
- CRP 252mg/l (<5mg/l)
- Urea 15.0mmol/l (2.5-7.8mmol/l) Creatinine 283µmo/l (59-104µmol/l)