A 52 year old man was admitted two weeks ago having been found collapsed - he had previously complained of malaise and a cough. A full blood count was asked for; the report form is included with the notes. A CT scan raised the possibility of a cerebellar infarct on the left side.

Previous history

A lumbar puncture was performed which showed the presence of Haemophilus sp. The patient was treated with Benzylpenicillin, he then became hypotensive, which was attributed to septic shock. It was noticed at this stage that he had a primary infection of the right ear.

The patient was admitted to ITU, sedated, and ventilated. Percutaneous tracheostomy was carried out uneventfully. He developed extensor responses to pain and up-going plantar reflexes, and was noted to have bronchial breathing at base of left lung; purulent material was aspirated from his airways, as the patient was too unwell to cough.

He deteriorated over the next few days and died.