A 47-Year-Old Man Develops Multiorgan Failure

Introduction. A 47-year-old man presented to the emergency room (ER) after a 2-day acute illness characterized by fever, prostration, and cough.

Patient history. Two days prior to presenting in the ER, the patient experienced a shaking chill. Overnight and into the morning, he became febrile and developed a cough, which progressed, along with his fever, sweats, and weakness. He took acetaminophen before presenting to the ER, but his symptoms remained. He developed pleuritic chest pain on his right side, and his cough was productive of bloody, rust-colored purulent sputum. He was also experiencing shortness of breath. His family reports that he seems to be confused and disoriented.

The patient’s personal medical history included decades of smoking (about one pack per day) although he denied any prior shortness of breath. He noted a "morning cough with sputum". He also drank significantly, likely well more than 2 drinks per day. He has a history of hypertension for which he takes an ACE inhibitor. He works in his family’s business as a certified public accountant. He is not married and lives in the household of his sister and brother-in-law.

Physical examination. The patient’s temperature was 103.4 F, pulse, 110/min, BP, 90/70 and respirations, 24/min. Salient findings included tachycardia without obvious murmurs and signs of consolidation in the right lung. Mucosae were dry.

Diagnostic testing. The patient’s laboratory tests included hematologic, metabolic, arterial blood gas, radiographic, and microbiologic findings. (Table 1).

Table 1. Diagnostic findings and interpretation