Infectious Disease
Case 11: A Patient with a Fever and Rash
CASE
A 17‐year‐old student was brought to the A&E department pyrexial and obtunded. Prior to this acute presentation he had flu‐like symptoms. On examination he was drowsy and had a Glasgow Coma Score (GCS) of 9 (eye 2; voice 2; motor 5) and febrile. He had a regular heart rate of 115 beats/min, arterial blood pressure of 105/77 mmHg and normal heart sounds. His abdomen was soft and non‐tender. The patient showed mild photophobia and neck stiffness and was Kernig positive. There was no focal neurology and fundoscopy was normal. On his trunk and thigh he had a petechial rash that was non‐blanching.
The following results were obtained
Hb 10 g/dL WCC 18 × 109/L (80% neutrophils) Platelets 90 × 109/L CRP 380 mg/L ESR 90 mm/h Na 138 mmol/L K 5 mmol/L Urea 10 mmol/L Creatinine 80 µmol/L LFTs Normal PT 20 sec APTT 50 sec Fibrinogen 0.5 D‐dimer Elevated
QUESTION 1
Your score this session: 0 of 0
Which of these investigations would be most appropriate?