Case 34-2006: A 72-Year-Old Woman with Nausea Followed by Hypotension and Respiratory Failure

A 72-year-old woman awoke from sleep with nausea that worsened during a 24-hour period. Evaluation disclosed pulmonary infiltrates, an elevated granulocyte count, hypoxemia, and hypotension; antibiotics were administered. Blood drawn later showed elevated levels of cardiac enzymes, and an electrocardiogram showed ST-segment elevation. Hypoxemia and hypotension worsened. A diagnostic procedure was performed. A 72-year-old woman awoke from sleep with nausea that worsened during a 24-hour period. Evaluation disclosed pulmonary infiltrates, an elevated granulocyte count, hypoxemia, and hypotension. An electrocardiogram showed ST-segment elevation. Presentation of Case Dr. David S. Frankel (Medicine): A 72-year-old woman was admitted to this hospital because of respiratory failure and hypotension. During the week before admission, the patient and other members of her family had symptoms of an upper respiratory tract infection. Five days before admission, the results of a routine annual checkup by her primary care physician were normal. Two days before admission, she awoke early in the morning with severe, intractable nausea and anorexia, without vomiting or diarrhea. During the next 24 hours, the symptoms worsened; a cough developed that was initially dry and was later productive . . .