After dinner on my night duty, I rushed to casualty as a patient was brought who needed immediate attention. On going to casualty, I saw that a 60 year old lady was struggling to breathe and appeared tachypnic. Her % oxygen saturation was only 86% at room air. We had to provide her immediate oxygen support which improved her saturation but she was still tachypnic , and opening her mouth to take in the air, basically struggling to take the air in. After making sure that her saturation was well maintaining I had called the attender to take a detailed history. Her complaints were not of recent onset. She had complaints since the past 4 months. The lady had been having complaints of burning micturition since 4 months. She had been visiting the hospital often for the above complaints. This time, she had the same complaints of burning micturition, fever, abdominal pain and decreased urine output. (figure 1) Figure 1 On asking further the attenders had told that she hadn