A 23-year-old woman presented to the emergency department with fever, headache, myalgia and frequent episodes of watery diarrhea since the previous day. Her temperature was 39.3[degrees]C, her heart rate was 132 beats/min and her blood pressure was 81/37 mm Hg. She had a decreased level of consciousness. Laboratory investigations showed a white blood cell count of 15.3 (normal 3.0-8.5) x 109/L, a platelet count of 140 (normal 150-361) x [10.sup.9]/L, a C-reactive protein level of 174 (normal 0-4) mg/L, an alanine aminotransferase level of 152 (normal 4-35) U/L and a creatinine level of 250 (normal 53-106) [micro]mol/L. We suspected a food-borne source of infection because the patient had eaten food past its expiry date a few days before symptom onset, and we could not find any other apparent sources of infection. We started empiric treatment for suspected sepsis with meropenem, aggressive fluid resuscitation and blood pressure support with norepinephrine.
After admission, we discovered that the patient had started menstruating 3 days before admission and had been using a tampon for about...