A 26 year old man presented with fever, cough, lightheadedness and generalised malaise for 36 hours. He had returned 2 days before from a hitch-hiking journey of 2 weeks in southwest Florida. An empirical course of Oseltamivir started 2 days before produced no improvement in symptoms. Seven hours into hospitalization, he develops profuse sweating and progressively worsening shortness of breath. His medical history is unremarkable. His psychiatric history is significant for bipolar disorder and chronic narcotic dependence. There is no history of allergies. He is a past tobacco smoker and former alcoholic, and occasionally uses marijuana.
There are bilateral diffuse hazy opacities in the lung fields consistent with the adult respiratory distress syndrome.
The ultrasound scan of the abdomen reveals no abnormalities. AST: 717 U/l ALT: 759 U/l Direct Bilirubin: 1.32 mg/dl Albumin: 4.2 g/dL (3.5 - 5)
The Indirect Fluorescent Antibody Test for R. Rickettsii is negative.
Culture reports will be available in 2 days.