Grand Round Case - A Young Man with Sore Throat, Acute Abdomen and Respiratory Failure

Over a period of 4 days, a previously fit and well 22-year-old man came twice to the emergency department with a history of sore throat, fever and neck pain for several days. At each visit he was treated symptomatically with paracetamol and sent home. Two days after the second visit, he was admitted to hospital with continuing sore throat and production of green sputum, fever, rigors and sudden onset of moderately severe abdominal pain localized to the right iliac fossa. His bowel function was normal and he had not lost weight. On direct questioning, he admitted to mild chest pain which appeared to be pleuritic in nature.