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A 19-year-old man with coeliac disease presented to the emergency department with an altered mental status and a rash over the last hour. He had worked all day and had eaten with his parents after work. Afterwards he went to bed feeling exhausted. At 20:30, he came downstairs and was confused, incontinent of urine and felt warm. There was a rash around his left eye. In the emergency department at 21:30, he had a fever of 38.8°C and a headache, and he vomited once. His airway and breathing were normal, and there was no tongue bite. He had a tachycardia but was normotensive. There was no meningism, but he was disorientated in time and there was right arm weakness. He had a rash around the left …
Contributors SH undertook the drafting of the article. SH and MF contributed to the patient’s initial clinical assessment. MF, EY and DW critically reviewed the manuscript and provided feedback.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Provenance and peer review. Not commissioned. Externally peer reviewed by Rhys Thomas, Newcastle-upon-Tyne, UK.
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