23rd May 2025

A 44-year-old female presented to ED with dyspnoea, high temperature and cough with green phlegm for 1 week.

A 44-year-old female presented to ED with dyspnoea, high temperature and cough with green phlegm for 1 week. On auscultation of the chest, there are crackles on the right side. Her observations are as follows: RR of 25/min; O2 saturations of 96% on 15L; BP is 94/50; and HR of 128 bpm. Patient is known to have T1DM, Graves’ disease, HTN, hypercholesterolemia, and had a STEMI 3 years ago. Her regular medications are  Levemir and Novorapid, carbimazole, ramipril, aspirin, simvastatin, and bisoprolol. 

Bloods show Hb 110 g/l, WBCs 2×109/L, Platelets 150×109/L, CRP 250 mg/L, Na 137mmol/L, K 4mmol/L, Urea 7 mmol/L, Creatinine 80 mmol/L, random blood glucose 10 mmol/L, serum ketones 0.01, BNP40 pg/ml. CXR (figure below). What is the most likely cause of her symptoms?

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