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26th May 2023
A 22-year-old patient presents to the emergency department with worsening nausea and urinary symptoms
A 22-year-old patient presents to the emergency department with worsening nausea and urinary symptoms. He now has flank pain and is pyrexial on examination; you also notice icteric sclera. He saw his GP 3 days ago and was prescribed nitrofurantoin for a presumed UTI. He admits to drinking 4 units of alcohol a week. He is otherwise fit and well, although a similar episode happened last year while backpacking through Africa. Bloods in ED show the following:
| Haemoglobin | 85 g/L | (130-180 g/L) |
| White cell count | 14.5 x 10⁹/L | (3.6-11.0 x 10⁹/L) |
| Platelets | 270 x 10⁹/L | (140-400 x 10⁹/L) |
| Bilirubin | 30 μmol/L | (1-17 μmol/L) |
| Urea | 15 mmol/L | (2.5-7 mmol/L) |
| eGFR | 60 ml/min | (>90 ml/min) |
What is the most likely underlying cause of this patient’s complication?
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