A man in his 40s presented to the ED complaining of chills and rigors. He had undergone prostate biopsy earlier that day. The patient denied cough, purulent sputum, shortness of breath, nausea, vomiting, or chest pain. He had a medical history of hypertension and hypercholesterolemia for which he took metoprolol and atorvastatin, respectively. Six months previous, he was found to have elevated prostate-specific antigen levels, which led to the biopsy.
On presentation, the patient was flushed, diaphoretic, febrile (temperature, 39.4°C), tachycardic (heart rate, 119 beats/min), normotensive (BP, 141/78 mm Hg), and breathing comfortably on room air. Physical examination was otherwise unremarkable, showing a normal precordial examination; good breath sounds bilaterally without rales; a soft, nontender abdomen; and no signs of rash. Initial blood work was unremarkable. A portable chest radiograph showed no signs of pneumonia or heart failure (Fig 1).