2-day history of flu-like...

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.

She appeared unwell, was mildly tender in the abdomen'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.