Pre Existing Spinal Cord Injury With Fever And Associated Ailments

A 20 year-old female with a pre-existing complete spinal cord injury from an MVA at the age of 2, presents with a 4 day history of fevers, lethargy, headaches and nausea. She has a long and complex medical history, including a sub-rectus sheath intrathecal baclofen pump inserted 2 years ago, several spinal fixation operations for spinal stability (the last 5 years ago), and chronic excoriation of both flanks from scratching. On examination she is GCS 15, her neurological level is unchanged, she has chronic neck stiffness but no photophobia. She is afebrile, her BP is her usual 90/60 mmHg, HR 100/min. Sats 97% RA, RR 14/min.

Apart from the scratch marks, the rest of her skin is intact with no pressure areas. Respiratory, cardiovascular, gastrointestinal, genitourinary and musculoskeletal exams are unremarkable. Initial investigations reveal an elevated WCC and CRP. What could be the…