<p>A 57-year-old woman was referred to the hospital by her general practitioner with a 2-day history of flu-like symptoms, tachycardia and hypotension. The symptoms included malaise, headache, vomiting, appetite loss, dizziness, and neck and joint pain. In addition, she had H/o hypothyroidism and was on adequate levothyroxine replacement. In addition to her acute symptoms, the patient reported 20 kg of weight loss, lethargy, skin darkening as shown in the figure.</p>

<p>She appeared unwell, was mildly tender in the abdomen&#39;s periumbilical region, and had hyperpigmented palmar creases. Blood tests showed hyponatremia with elevated urea and creatinine and decreased estimated GFR 55 mL/min. The CRP and ACTH were markedly elevated. In addition, her plasma renin activity (PRA) was elevated at 12 ng/mL/h. Adrenal autoimmunity was positive, and the real-time PCR tests were positive for influenza virus type B RNA. The chest X-ray and abdominal X-ray showed no acute pathology. The patient was diagnosed, and the appropriate management plan was established. In addition to the diagnosis, she was advised to obtain a medical alert depicting that she had autoimmune polyglandular syndrome type 2 (APS 2) and steroid replacement.</p>