26th August 2024

A 28-year-old woman with no past medical history is admitted with dysuria, flank pain and fevers

A 28-year-old woman with no past medical history is admitted with dysuria, flank pain and fevers. She is treated with antibiotics for likely pyelonephritis. Five hours after admission, you are asked to review her urgently. On review, you find her slumped in the bed, her voice is weak and breathy and she seems to be having trouble swallowing a lot of secretions at the back of her throat. She reports, in broken sentences, feeling like she’s drowning but has no chest pain.

She is tachypnoeic, taking short, shallow breaths at a rate of 45 per minute. On examination, there are secretions at the back of her throat but no swelling of the mouth, face or airway, her chest is clear with no added sounds or wheeze, but you note that she is working hard and using her accessory muscles to breathe. You note that she is weak in both arms and legs. You lie her down to examine her abdomen but find that her breathing deteriorates further in this position.

What is the most likely cause for this patient’s symptoms?

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