History A 27-year-old woman is admitted to the emergency department complaining of pain across her back. She became unwell 2 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 6 h. She has had no previous significant medical history apart from an uncomplicated episode of cystitis 3 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. What is the likely diagnosis? *This image-based case is from Docplexus editorial team for educative purpose only Source: 100 cases in clinical medicine
