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... He was admitted to the intensive care unit. There, he was quickly intubated and put on mechanical ventilation. Then, his cardiovascular system started to fail. He went into severe shock. His kidneys shut down, and doctors started dialysis. He was soon heavily sedated on fentanyl and other drugs while machines kept him alive. The case and the path to his diagnosis was published Wednesday in the New England Journal of Medicine. ...

Diagnostic challenge

The man's medical history offered few clues as to what could be going on. He was generally healthy and worked in an office without any risky occupational exposures. He had a history of gallstones and a recent root canal"nothing obviously concerning. He had been camping recently in a rural area of Chascoms, south of Buenos Aires. But he reported no insect bites, contact with rodents, or other exposures.

Lab results showed that his blood had abnormally high concentrations of red and white blood cells, and low levels of platelets. He tested negative for a slew of infections, including COVID-19 (again), influenza, HIV, dengue, and the bacterial blood infection leptospirosis.

Computed tomography (CT) scans of his lungs showed more ground-glass opacities as well as a "halo sign," a ------ on scans that sometimes signals invasive fungal infections. There were also signs of lung collapse and fluid buildup (edema).

It was a diagnostic challenge, and doctors began reviewing the list of possibilities that could match his condition. ...