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?

CC6
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!