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8th July 2024
A 38-year cold is brought in by ambulance. She is visibly short of breath and delirious
A 38-year cold is brought in by ambulance. She is visibly short of breath and delirious, unable to give a clear history. From the ambulance handover, she had a simultaneous kidney pancreas transplant 4 months ago and is on immunosuppressants. Her brother arrives and tells you she has been unwell with a dry cough and increasing shortness of breath since yesterday. She is on Tacrolimus, MMF, Prednisolone, Aspirin, Ramipril and Atorvastatin. Her vision is poor due to diabetic retinopathy.
Observations and imaging:
| Blood Pressure | 98/40 mm HG |
| Heart Rate | 118 /min |
| SpO2 | 87% on RA, 92% 8lit O2 |
| Temperature | 39 ⁰C |
| Urine analysis | 1+Protein |
| Chest X-Ray | Bilateral infiltrates with right sided pleural effusion |
| ABG on RA | pH 7.3, paO2 6.8, paCO2 5.4, HCO3 20, Lactate 2.0 |
| Antigen SARS-CoV2 | Negative |
Laboratory analysis:
| Haemoglobin | 10.2 g/dl | Sodium | 138 mmol/dl |
| White Blood Corpuscles | 8.2 x 10^6 | Potassium | 5.5 mmol/dl |
| Platelets | 156 x 10^6 | Corrected Calcium | 2.32 mmol/dl |
| Creatinine | 102 mmol/dl | Phosphate | 0.9 mmol/dl |
| Urea | 5.6 mmol/dl | CRP | 123.8 mg/l |
| Albumin | 32 mg/l | Glucose | 4.0 mmol/dl |
What is the most likely cause of this presentation?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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