A 72-year-old woman developed a chest infection and she is being treated with doxycycline by her GP. The GP found her blood pressure 138/82 mmHg. For 5 days, she has been feverish and anorexic and confined to bed. Her daughter has made her drink plenty of fluids. On the 5 th day she became drowsy, family had increasing difficulty in rousing her, so she was taken to emergency department. History The patient has a long history of rheumatoid arthritis, which is still active and for which she is taking 7 mg of prednisolone daily for 9 years. She takes paracetamol occasionally for joint pain.
There is no other relevant past or family history. Examination She is small (50 kg), but no evidence of recent weight loss. Temperature is 38.8°C. She is drowsy and responds to commands but doesn’t answer simple questions. Global reduction in muscle tone but no focal neurological signs. Pulseis 118/min,…
