A previously healthy 33-year-old man was transferred to our hospital with hypotension, cardiac systolic dysfunction, respiratory failure, and renal insufficiency. He had been admitted 2 days before to an outside hospital following a 5-day history of cough, pharyngitis, myalgias, arthralgias, and a transient salmon-colored truncal rash associated with fluctuating fevers. He received therapy with broad-spectrum antibiotics, but his condition continued to deteriorate, requiring mechanical ventilation and vasopressors. Chest radiographs at the outside hospital revealed a left lower lobe pneumonitis, and an echocardiogram revealed an ejection fraction of 30 to 35% with global hypokinesis. Because of his continued deterioration, he was transferred to our hospital.