A 47-year-old male presented to the emergency department with worsening generalized abdominal pain, which was aggravated by movement and associated with nausea and vomiting. He also reported fever, dry cough, and mild dyspnea. His past medical history included diabetes mellitus, hypertension, and morbid obesity with a body mass index (BMI) of 59.18. On initial evaluation, his vital signs were unremarkable. Oxygen saturation was 92% on room air. His lung exam was normal. The abdominal exam revealed generalized tenderness without guarding. His chest X-ray (CXR) showed bilateral multiple patchy infiltrates. A chest computed tomography (CT) scan revealed bilateral ground-glass opacification. An abdomen CT was performed, which illustrated the dilation of fluid-filled appendix and infiltration of the surrounding fat. Laboratory results were as follows: white blood count (WBC) 10.37 x103 cells per cubic millimeter with lymphocytes of 13.5%, C-reactive protein 11.55 (mg/dl) (normal <0.4 mg/dl), ferritin 1376 (ng/mL) (normal 30-400 ng/mL), D-dimer 356 ng/mL (normal <230 ng/ml), lactate dehydrogenase (LDH) 393 (U/L) (normal 135-225 U/L), and procalcitonin 0.17 ng/ml (normal: <0.09 ng/ml). His creatinine was significantly increased to 1.35 mg/dl as compared with his baseline at 0.83 mg/dl.
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