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Case presentation
A 25 year-old man presents to the medical admissions unit complaining of headache, neck stiffness and photophobia. PMH. He has had a right-sided ear ache over the last two weeks but is otherwise fit and well. DH. He is on no regular medication and has no allergies. SH. He lives alone and works as a car mechanic.
On examination
Temperature 38.2C, HR 90 min and regular, BP 115/70 mmHg, JVP not raised, RR 16/min, O2 sat 99% on air, HS I + II + 0, chest sounds clear with equal air entry throughout. Neurological examination demonstrates photophobia, neck stiffness and a positive Kernig’s sign.
Investigations
Hb 153 g/L (115–165), WCC 17.8 × 109/L (4.0–11.0). Na+ 140 mmol/L (137–144), K+ 4.5mmol/L (3.5–4.9), U 5.0mmol/L (2.5–7.0), Cr 80 µmol/L (60–110), eGFR 90, CRP 70 mg/L (<5)
