Infectious Disease
Case 3: A Patient with Flu‐Like Symptoms and a Rash
CASE
A 25‐year‐old man who was previously fit and well presented with a 4‐day history of headache, myalgia and arthralgia followed by a dry cough. He initially thought he had the flu but his symptoms progressed. He then developed a generalized rash on his trunk, which led to his admission. He denied having a fever and had not travelled recently. He did not take any medication or use illicit drugs.
On examination he was jaundiced, had a temperature of 37.8°C, a heart rate of 110 beats/min, an arterial blood pressure of 105/70 mmHg, and a respiratory rate of 25 breaths/min with an oxygen saturation of 93% on air. He had bronchial breathing in his right upper lobe, normal heart sounds and a soft abdomen with no evidence of organomegly. Central nervous system examination was normal and there was no meningism or papilloedema on fundoscopy. On close scrutiny of the rash on his trunk you see multiple target lesions.
His blood results are below.
Hb | 9 g/dL |
WCC | 12 x 109/L |
Neutrophils | 10 x 109/L |
Platelets | 600 x 109/L |
ESR | 60 mm/h |
Clotting | Normal |
Direct Coombs’ test | Positive |
Na | 145 mmol/L |
K | 3.7 mmol/L |
Urea | 10 mmol/L |
Creatinine | 115 mmol/L |
Bilirubin | 50 μmol/L |
ALT | 23 U/L |
ALP | 60 U/L |
GGT | 60 U/L |
Albumin | 27g/L |
CRT | 198 mg/L |
QUESTION 1
Your score this session: 0 of 0
Which of these blood markers most strongly suggest a bacterial infection?