A cold taken to heart

A 35-year-old woman with no past medical history presented to her local emergency room with 2 days of fevers, chills, and myalgias. She was febrile with a temperature of 102°F, blood pressure of 95/60 (72) mm Hg, heart rate of 110 bpm, respiratory rate of 20 breaths per minute, and an oxygen saturation of 100% on 2 L oxygen. The physical examination was notable for cool extremities, clear lungs, and tachycardic heart sounds with no s3, s4, or friction rub. The patient decompensated quickly and developed hypotension, requiring rapid uptitration of norepinephrine to 12 μg · kg^-1•min^-1. The ECG (Figure 1) showed sinus tachycardia with ST-segment elevation in the inferolateral leads. Laboratory results were notable for cardiac troponin of 3.89 ng/mL (normal range, 0-0.08 ng/mL), venous lactate of 3.5 mmol/L (normal range, 0.50-2.20 mmol/L), white blood cell count of 17.0×109 per 1 L (normal range, 3.5-9.1×109 per 1 L), and hemoglobin of 12.4 g/dL (normal range, 13.3-16.2 g/ dL) with preserved hepatic and renal function.