一位72岁的女性病患，曾患肺腺癌，并接受奥西替尼酪激酶抑制剂治疗，因严重疲劳和发热而被送入急诊室。她在上呼吸道感染症状出现后，已由家庭医生开始使用抗生素治疗。她有发热（38.5°C），除了白细胞增多和C-反应蛋白升高外，其他实验室指标正常。因其严重的全身不适，她住院治疗。基于医生对重症病毒性喉炎的初步推断，抗生素治疗被停止，只采取支持性措施。在接下来的3天里，她的病情恶化，通过超声波检查发现她出现了呼吸系统症状，并出现右侧胸腔积液。随着时间的推移，患者变得越来越糊涂和嗜睡。尿量保持正常，肾小球滤过率稳定在57 mL/min。进一步检查显示，胆红素水平和凝血功能正常，表明没有相关的慢性肝脏疾病。临床上没有脑膜炎的征象。除了低剂量镇痛药物外，没有给予可能导致她糊涂的麻醉药物。住院第四天，她被转到休克室进行紧急稳定和诊断，因极度脑病和氧气需求增加。版权所有© 2023年美国胸科医师学会。Elsevier Inc.发表，保留一切权利。

A 72-year-old woman with a history of adenocarcinoma of the lung, for which she was receiving tyrosine kinase inhibitor therapy with osimertinib, was admitted to the ED because of clinical deterioration with extreme fatigue and fever. She was already receiving antibiotic therapy initiated by her general practitioner because of symptoms of an upper respiratory tract infection. She was febrile (38.5 °C) with normal laboratory values except for leukocytosis and elevated C-reactive protein. She was hospitalized because of profound general malaise. On the basis of the physician's working hypothesis of severe viral laryngitis, the antibiotic therapy was stopped, and only supportive measures were taken. Over the next 3 days, her condition deteriorated, and she developed respiratory symptoms with a right-sided pleural effusion demonstrated by ultrasound examination. Over time, the patient became increasingly confused and drowsy. There was preserved urinary output and a stable glomerular filtration rate of 57 mL/min. Further on, bilirubin levels as well as coagulation were normal, indicating the absence of any relevant underlying chronic liver condition. Clinically, there were no signs of meningitis. No sedative medications that would explain her confusion were given except for low-dose opioid analgesics. On day 4 after hospitalization, she was transferred to the shock room for immediate stabilization and diagnostics because of profound encephalopathy and increasing oxygen requirements.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.