Thanks Dr Peter Ritchie for forwarding this article about an interesting case.

Key points:

1. Rarer diagnoses are often encountered in daily ED practice hidden amongst common symptoms
2. attention to details that do not fit usual patterns (eg. in this case abnormal renal function that was not accountable by dehydration, abnormal liver function tests; band forms on full blood count) may re-direct the clinician to new differentials and help stall diagnosis momentum