ID Fellows Cup Question 15

A 35 year-old with hypertension presents to the emergency department with 4 days of fevers, productive cough, and dyspnea in mid-July. Associated symptoms include diffuse abdominal pain, watery diarrhea, and headache. She lives alone in Chicago and is without recent travel history or healthcare exposures.

On exam she is febrile, HR 90, RR > 30, hypotensive but responded to aggressive volume resuscitation and hypoxic requiring high flow nasal cannula. Labs are notable for hyponatremia and mildly elevated serum creatinine and AST/ALT. NP swab for COVID-19 is negative, Chest x-ray is shown.

CXR

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