A 52-year-old woman presents to the Emergency Department in June for fevers and myalgias for 3 days. She lives in New Mexico but went hiking a month ago in Vermont and reports pulling a tick off herself after hiking. She also recently cleaned out her basement where she noted mice droppings. She has not travelled internationally recently.
She was febrile to 102°F, tachycardic, with O2 saturation 95% on room air, and hypotensive. Conjunctivae were clear. No hepatosplenomegaly. No rash was noted.
Laboratory results were notable for leukocytes 4,500 cells/mm3, platelets 102,000/mm3, creatinine 0.8 mg/dL, aspartate aminotransferase 355 U/L, alanine aminotransferase 180 U/L. Chest radiograph showed clear lung fields.
Two days into her hospital course she developed a dry cough and shortness of breath and ultimately intubated. Chest radiograph is shown below:
Laboratory results were notable for platelets 18,000/mm3, creatinine 1.0 mg/dL, aspartate aminotransferase 329 U/L, alanine aminotransferase 258 U/L, and lactate dehydrogenase 769 U/L. No parasites noted on a blood smear.