Hypotension and Hypoxia in a 36-Year-Old Man With HIV Who Recently Began Treatment for a Fungal Infection

LT Renée S. Lemieux, MD; William Goldenberg, MD


June 05, 2023

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A 36-year-old man with a recent diagnosis of HIV infection is brought by ambulance to the emergency department (ED). He has an oxygen saturation level of 80% on a nonrebreather mask and a systolic blood pressure of 60 mm Hg measured by palpation. The paramedics were initially concerned about anaphylactic shock based on information that the patient had started taking voriconazole 1 week earlier for coccidioidomycosis. The paramedics reported that he had angioedema, for which two doses of 0.3 mg intramuscular epinephrine, 50 mg intramuscular diphenhydramine, ipratropium bromide–albuterol sulfate, and 1 L of normal saline were administered en route to the ED.

The patient's family told the paramedics that he had been having coffee ground emesis. He has difficulty elaborating on his past medical history owing to his respiratory distress. He has no past surgical history, and his social history includes daily alcohol consumption, cigarette smoking, and methamphetamine use.


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