A 22-year-old patient presenting with seizures and migratory pulmonary infiltrates

A 22-year-old male patient presented with a fever for the previous 10 days, breathlessness with dry cough for the previous 3 days and decreased urine output since the morning of admission. His history was unremarkable. He denied any history of joint pain, rashes, eye symptoms, haemoptysis or sinus disease and there was no history of illicit drug abuse. He was a nonsmoker with no history of alcohol intake and was not on any regular medications. Clinical examination revealed icterus, blood pressure of 130/85 mmHg, tachycardia (130 beats?min), tachypnoea (30 breaths?min) and a temperature of 39uC. His upper airways were normal on examination and there were reduced breath sounds and crackles at the right lung base. The rest of the system examinations was unremarkable. Initial relevant investigations are summarised in table 1. The capillary blood glucose was 117 mg?dL. His typhoid and dengue serology along with dual malarial antigens were all-negative. An electrocardiogram showed sinus tachycardia. Arterial blood gases on air showed type 1 respiratory failure with a pH of 7.39, an oxygen tension (PO2) of 56 mmHg, a carbon dioxide tension (PCO2) of 32 mmHg, bicarbonate 25 mmol?L and lactate of 2.9 mmol?L. Urine dipsticks showed 1+ proteinuria. A chest radiograph was performed (fig. 1).