Case Challenge #6

A 34 yo male with AIDS, currently on treatment for disseminated Histoplasmosis, is admitted with fever and hypotension. He has been on therapy for this infection for the last 4 months, and was doing well. However, he notes that he has become gradually more tired and has a decreased appetite. 2 days prior to this presentation, he underwent emergency surgery for a broken arm after a fall. After the procedure, he developed fever and hypotension on POD #1 and broad spectrum antibiotics were started. Currently, he remains febrile and has nausea, vomiting, and abdominal pain.

PE: Tmax 100.8, HR 115, BP 90/60. Abd TTP but no rebound.

Labs: WBC 12k (70% PMN, 5% Eos), h/h stable, Na 128, K 5.4, Cr 1.6, blood Cx ngtd.


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