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Pulmonary puzzle
Eosinophilia, meningitis and pulmonary nodules in a young woman
  1. Paul E Pfeffer1,
  2. Arjune Sen2,
  3. Satya Das3,
  4. Michael Sheaff4,
  5. Anand Sivaramakrishnan5,
  6. David E Simcock6,
  7. Benjamin Turner7
  1. 1Department of Respiratory Medicine, Royal London Hospital, London, UK
  2. 2Department of Neurology, University College London Hospital, London, UK
  3. 3Department of Microbiology, Royal London Hospital, London, UK
  4. 4Department of Histopathology, Royal London Hospital, London, UK
  5. 5Department of Microbiology, Royal London Hospital, London, UK
  6. 6Department of Respiratory Medicine, Royal London Hospital, London, UK
  7. 7Department of Neurology, Royal London Hospital, London, UK
  1. Correspondence to Dr Paul E Pfeffer, c/o Dr David Simcock, Department of Respiratory Medicine, Royal London Hospital, London E1 1BB, UK; paulpfeffer{at}hotmail.com

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A 22-year-old woman was admitted unwell with headache, fever and encephalopathy. She was born in the UK to parents from Hong Kong. She had a past history of asthma, perennial rhinitis and atopic dermatitis for which she took a budesonide 100 μg turbohaler and beclomethasone nasal spray. Three weeks before admission she had returned from holiday in Valencia and shortly after her return developed a flu-like illness followed by worsening asthma symptoms. Despite increasing usage of her corticosteroid turbohaler to eight puffs a day, her cough and wheeze worsened. Her GP prescribed a 5-day course of prednisolone 50 mg daily (approximately 1 mg/kg). Her asthma symptoms improved but she developed a headache 2 days after finishing the corticosteroid course. Over the next 5 days she became more unwell with worsening headache …

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