MRCP2-0418

MRCP2-0418

A 35-year-old man presents to the Emergency Department (ED) with a history of general malaise, weight loss, and arthralgia. He has recently returned from a holiday abroad and mentions visiting a tattooing parlour where he had an erythematous skin rash around the tattoo site. He also describes episodes of waking up at night feeling really hot. On examination, he is found to be pyrexia and tachycardia, with petechial haemorrhages in his conjunctival and buccal membranes. An ECG shows sinus tachycardia with a PR interval of 220 ms and a urinary dipstick is positive for blood. His investigations reveal a Hb of 141 g/l, WCC of 15.6 × 109/l, PLT of 153 × 109/l, Na+ of 136 mmol/l, K+ of 4.8 mmol/l, Cr of 83 μmol/l, and urea of 5.0 mmol/l, with a CRP of 13.5 mg/l. What is the most likely diagnosis?