ABSTRACT
A 43-year-old man presented to the emergency department with a 6-day history of fevers and a cough productive of green sputum. He described feeling fatigued for more than a month and had unintentionally lost around 1 stone in weight over this time. His past medical history included a functioning cadaveric renal transplant 3 years earlier, after developing renal failure secondary to autosomal dominant polycystic kidney disease (APKD). He took regular tacrolimus, mycophenolate mofetil, prednisolone and omeprazole. He worked as a part-time legal secretary. He did not smoke and drank around 6 units of alcohol per week.
