Bigger than his bite

A 58-year-old male presented to a local community hospital emergency department with fever and altered mental status. Earlier in the day he had complained of chills, swollen tongue, numbness and tingling in his extremities with associated burning pain, and generalized weakness. En route to the emergency department, he was extremely agitated and moving uncontrollably. On arrival, he was noted to be in respiratory distress and was intubated for hypoxic respiratory failure. He was subsequently transferred to an academic medical center, and in transit was noted to have sustained supraventricular tachycardia with a heart rate of 160 beats per minute.