 This 48-year-old white married female presents in the emergency room after two days of increasing fever with recent diagnosis of urinary tract infection on outpatient treatment with nitrofurantoin.  The patient noted since she began to feel poorly earlier on the day of admission, had an episode of substernal chest discomfort that was associated with nausea, dizziness, and sweating.  The patient does have a past medical history of diabetes and hypertension.  In addition, the patient complained of some neck and head discomfort for which she underwent a lumbar puncture in the emergency room; this was normal, causes turned out to be normal as well.  The patient denies nosebleed, visual changes, nausea, vomiting, diarrhea or changes in bowel habits.  She has not had any musculoskeletal or neurological deficits.  She denies any rashes or skin lesions.