Answer to CC #6

Case Challenge #6 presented a 34 yo male with AIDS and disseminated histoplasmosis who presents with fever, hypotension, eosinophilia, hyponatremia, and hyperkalemia.

Which of the following is most likely to make the diagnosis?

The correct answer is:

Cosyntropin Stimulation Test

The patient has ADRENAL CRISIS!
  • Can mimic sepsis with fevers, nausea, abdominal pain, and hypotension
  • Typical scenario: Patient presents in shock after recent stressor (surgery, acute illness) in individual with risk factors for adrenal insufficiency (recent steroids, infection such as TB or Histo with predilection for adrenals)
  • Classic labs: Hyponatremia, hyperkalemia, hypoglycemia, eosinophilia

Great job! A review of adrenal insufficiency is on the way. Challenge # 7 is coming up!