ABSTRACT
A 58-year-old man has presented to the emergency department with a nose-bleed and bleeding gums, which have continued for nearly 24 hours. He also has a fever, cough and shortness of breath which appeared over the past few days. Prior to this he had been fairly well. He has a medical history of hypertension, hypercholesterolaemia, psoriasis and osteoarthritis of the hips. He has taken methotrexate for his psoriasis for two years, as well as omeprazole, bendroflumethiazide, ramipril and paracetamol. He has no allergies. He does not smoke or drink alcohol.
