The case:

19 year old male who presented as ‘lethargic & generally unwell’ is wheeled into resus. He is so weak it takes 2 staff and his father to lift him from the wheelchair to our stretcher.

He looks horrible. A mixture of white & grey. Clammy & diaphoretic. Pulse 130/min (sinus). BP 92systolic. He looks dry. Chest clear with sats of 95% on room air. No murmurs. JVP not seen.

The nurses have quite rightly initiated our ‘Septic-Pathway’ designed to rapidly initiate IV access, cultures, lactate, fluids & early antibiotics.

As your first saline bolus is rushing in, he reports having generalised lethargy & malaise for 4-5 days during which time he has not gotten out of bed… He has had fevers, drenching night sweats and rigors. Minimal cough but no dyspnoea.

Systems review & closer examination brings you no closer to finding the source of sepsis.

It does cross my mind that he has a horrible case of ‘man-flu’ …

Bloods are unhelpful. WCC normal. CRP 33. EUCs normal.

For me, his CXR changed my mind & subsequent course of action….

What are your thoughts ? DDx ?

What would you do next ??

The conclusion can be found here…. more than man-flu (part2)…