Case 3

A 20-year-old student is brought in by friends who are concerned that she is behaving 'strangely'.

She has recently returned from Kenya where she had taken Malarone for malaria prophylaxis. She was seen by her GP five days ago with abdominal pain and nausea, and has been treated for a UTI.

Yesterday, she complained to her friends of headache and flu-like symptoms, and today she has complained of cramping, and pins and needles in her hands.

On examination, you find that she is sweaty and has a tachycardia of 120/minutes, BP 110/80 and RR 20/minutes. She has neck stiffness and appears to be having uncontrolled movements of the facial muscles, neck muscles and carpo-pedal spasm.

Her temperature is 37.5° C and she has no rash or skin changes.

Can you list at least three possible diagnosis for this patient?

What five items in her history would you like to know?

Can you name at least three blood tests that could help you establish a diagnosis?

You call her GP to find out her immunisation status.

The receptionist tells you she had a script five days ago for Trimethoprim and metoclopramide.

How might you determine if this is a reaction to the metoclopramide?