Case presentation A 27-year-old woman is admitted to the emergency department complaining of pain across her back. She became unwell two days previously when she started to develop a fever and an ache in her back. The pain has become progressively more severe. She has vomited twice in the past six hours. She has had no significant medical history apart from an uncomplicated episode of cystitis three months ago. Examination She looks unwell and is flushed.
Her temperature is 39.5°C. Her pulse is 120 beats/min, and blood pressure is 104/68 mmHg. Examination of the cardiovascular and respiratory systems is unremarkable. Her abdomen is generally tender but most markedly in both loins. Bowel sounds are normal. Hb: 15.3 g/dL WCC: 25.2 × 10 9 /L Platelets: 406 × 10 9 /L Sodium: 134 mmol/L Potassium: 4.1 mmol/L Urea: 14.2 mmol/L Creatinine: 106 μmol/L Albumin: 44 g/L C-reactive protein (CRP):…
