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Pulmonary, Critical Care, and Sleep Pearls |

A 47-Year-Old Returning Traveler With ShockReturning Traveler With Shock

Hardik Soni, MD; Viral Gandhi, MD; Sohan Varma, MD; Deepinder Kaur, MD; Oleg Epelbaum, MD, FCCP
Author and Funding Information

From the Department of Internal Medicine (Drs Soni, Gandhi, Varma, and Kaur) and the Division of Pulmonary and Critical Care (Dr Epelbaum), Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.

CORRESPONDENCE TO: Viral Gandhi, MD, Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, 7901 Broadway, Elmhurst, NY 11373; e-mail: dr.viralgandhi@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):e8-e12. doi:10.1378/chest.14-0615
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A 47-year-old man with no significant past medical history, originally from Indonesia, was brought to the ED of an urban US medical center after being found collapsed on the sidewalk in respiratory distress and with an altered sensorium. Upon arrival to the ED, he was tachypneic, with increased work of breathing and an oxygen saturation of 88% on 100% nonrebreather mask, so he was immediately intubated. Following intubation, he became profoundly hypotensive, requiring aggressive crystalloid resuscitation and vasopressor support. Broad-spectrum antimicrobials were administered, including ceftriaxone, vancomycin, levofloxacin, and oseltamivir. Further history elicited subsequently from family members revealed that the patient had returned from a 2-week vacation in Indonesia 6 days prior to presentation. According to relatives, he appeared to be in his usual state of health upon his return and was not seen by anyone thereafter, but in the interim he reportedly had an episode of epistaxis, and text messages received from him became progressively more bizarre.

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shock ; traveler

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