title: A 47-year-old returning traveler with shock.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.; Division of Pulmonary and Critical Care, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.
authors.forename: Hardik
authors.initials: H
authors.lastname: Soni
authors.affiliation: Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.; Division of Pulmonary and Critical Care, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.. Electronic address: dr.viralgandhi@gmail.com.
authors.forename: Viral
authors.initials: V
authors.lastname: Gandhi
authors.affiliation: Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.; Division of Pulmonary and Critical Care, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.
authors.forename: Sohan
authors.initials: S
authors.lastname: Varma
authors.affiliation: Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.; Division of Pulmonary and Critical Care, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.
authors.forename: Deepinder
authors.initials: D
authors.lastname: Kaur
authors.affiliation: Division of Pulmonary and Critical Care, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.; Division of Pulmonary and Critical Care, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.
authors.forename: Oleg
authors.initials: O
authors.lastname: Epelbaum
mesh_terms: D000914:Antibodies, Viral / Q000032:analysis; D003716:Dengue Virus / Q000235:genetics / Q000276:immunology; D003937:Diagnosis, Differential; D006801:Humans; D007214:Indonesia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D019595:Severe Dengue / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology; D012772:Shock, Septic / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology*; D014195:Travel; D014481:United States / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral