She reported an eight day history of dry cough and fever (39.2°C) associated with sore throat and nasal congestion. She lived in a peripheral urban area. On emergency room examination, her Glasgow Coma Score (GCS) was 12 (E = 3 V = 4 M = 5), temperature was 39.6°C, blood pressure was 80/40 mm Hg, heart rate was 54 beats per minute, respiratory rate was 40 breaths per minute and oxygen saturation was 88% on 50% inspired oxygen. Her chest radiograph was consistent with multifocal pneumonia (Figure 1 ). There were rhonchi in the left and right lung fields. A rapid test of a specimen from a buccal swab was negative for influenza A and B antigens, and no parasites were seen on a peripheral-blood smear. Acetaminophen, ketorolac, levofloxacin and normal saline were administered.