Case history

A 28-year-old man with a schizoaffective disorder jumped off a 30-foot bridge sustaining bilateral tibial and fibular fractures. He required fluid resuscitation, but his Glasgow Coma Scale score was 15 and there was no respiratory compromise. He underwent external fixation of the leg fractures, and was extubated postoperatively. However, within 24 hours he developed respiratory distress associated with deteriorating conscious level, requiring reintubation. Chest radiograph showed patchy shadowing in both lungs (figure 1), but CT scan head was normal. He was started on antibiotics for suspected aspiration pneumonia, but his serum C-reactive protein continued to rise. He underwent wound debridement and his antibiotic treatment was escalated. He failed to improve and had persistent fever and tachycardia. MR scan of brain was performed and a neurology opinion was requested.

On …