A 17-year-old woman with a history of sexually transmitted disease and productive cough who developed cardiogenic shock.

Case Presentation History A 17-year-old woman presented at the emergency room with a chief complaint of productive cough for 1 month, fever, and rigors. One month before admission, she had developed a productive cough with greenish sputum. Two weeks later she noticed some bloody streaks in the sputum and she subsequently developed fever and rigors. She was seen in a local clinic and started on cough syrup and phenergen, but she did not improve. The other associated symptoms were fatigue, subjective fever, anorexia, dyspnea, pleuritic chest pain, a 20-pound unintentional weight loss, nausea, and vomiting. She denied hematemesis, melena, or dysuria. She had no myalgias, arthralgias, headache, abdominal pain, palpations, or diarrhea. Her medications on admission included cough syrup and phenergen. She had no history of thyroid disease, cardiac murmur, anemia, heat intolerance, or palpitations. She was gravida 1, para 1. Her last menstrual period was 1 month before admission. There was no history of menstrual irregularities. Her family history was not contributory. With regard to social history, she denied smoking or use of alcohol or intravenous drugs. She had a history of treatment for syphilis 3 years before admission. She had one sexual partner for the past 2 years. She had no history of tuberculosis. In 1990, a PPD test and an HIV test were reportedly negative. She had had no blood transfusions in the past.