A 58-year-old patient presented to the emergency department with the chief complaints of bleeding nose and gums, from nearly 24 hours. He also has a fever, cough and shortness of breath which appeared over the past few days. Medical history : He has hypertension, hypercholesterolemia, psoriasis and osteoarthritis of the hips. He has taken methotrexate for his psoriasis for two years, as well as omeprazole, bendroflumethiazide, ramipril and paracetamol. He has no allergies. Physical Examination CNS: alert and oriented.
Bruising present over his arms and legs. Cardiovascular, neurological and abdominal examinations are unremarkable. RS: Reduced air entry at the left base with inspiratory crackles, and a chest X-ray shows left basal consolidation. No lymphadenopathy is found. ECG - sinus tachycardia. Temperature 38.2°C, blood pressure 110/78 mmHg, heart rate 101/min, respiratory rate…
