A 36-year-old woman with Down's syndrome and spleen hypo-plasia presented with a fever of 40°C lasting for 12 hours. She had taken 1 mg prednisolone/day for mild graft-versus-host disease after allogeneic stem cell transplantation 4 years previously. Her BP was 91/44 mm Hg, HR 110 beats/min and RR 30 breaths/min. Her heart sound, lung sound, and skin appearance were unremarkable. Laboratory findings showed leucocytosis (13.12×109/L) and normal platelet count (269×109/L). She was discharged home, but 16 hours after fever onset, experienced cardiopulmonary arrest.

Figure 1. The patient's appearance on readmission.

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