The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
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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Cite this: Hypotension and Hypoxia in a 36-Year-Old Man With HIV Who Recently Began Treatment for a Fungal Infection - Medscape - Jun 05, 2023.