Unspecified hospital in Adelaide

73-year-old male day 1 ICU admitted following a MET call for decreased conscious state that required intubation. He had been admitted with shortness of breath, fever, headache and collapse and found to have meningococcal meningitis. Background included ischaemic heart disease on dual anti-platelet therapy and COPD. Findings on examination included ecchymoses, bronchial breathing left lung, right upgoing plantar and the absence of meningism.

Candidates were directed to determine the likely cause for the decrease in conscious state.

Discussion points included interpretation of the CSF results, management of meningitis and the role of steroids.