23rd January 2024

A 22-year-old female presents to the emergency department with a 2-day history of fever

A 22-year-old female presents to the emergency department with a 2-day history of fever, myalgia, abdominal pain, and restlessness. She has also developed dyspnoea, pleuritic chest pain, and a cough. There is no significant medical history. She had recently travelled to Sri Lanka. On examination, she is hypotensive with a narrow pulse pressure, and her pulse is weak and rapid. The tourniquet test is positive. She is resuscitated with intravenous (IV) crystalloids, though does not improve. Her most recent blood tests, taken before the first bolus, reveal thrombocytopenia, hypoalbuminaemia, and a relatively low haematocrit.

Which of the following is the most appropriate management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.