5. All of the above

An explanation for her overall clinical picture is not clear. Certainly, she could be septic and broad spectrum antibiotics while awaiting culture results is reasonable. Hypoglycemia has been associated with increased mortality and glucose infusion to maintain a glucose is indicated. She is hypotensive from apparent cardiogenic shock but adrenal insufficiency is common in ICU patient and stress dose corticosteroids while awaiting cortisol levels is reasonable.

Blood cultures, sputum and urine cultures were all negative for pathogens. Cortisol levels were normal. Three days after transfer she developed pancytopenia with a white blood cell count dropping below 1000 cells/mcL. She was undergoing daily or every other day dialysis because of her renal failure and anuria.

Which of the following are possible explanations of her overall clinical picture? (Click on the correct answer to proceed to the fourth of five pages)

  1. DRESS syndrome
  2. Hemophagocytic lymphohistiocytosis
  3. Sepsis
  4. 1 and 3
  5. All of the above

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