| Summary: | No abstract available. Article truncated at 150 words. History of Present Illness The patient is a 64 year old man who had suffered a non-orthostatic syncopal episode at home, shortly after the onset of lightheadedness. The patient was transported to an outlying hospital where he was described to be confused, wheezing, and in respiratory distress. He was said to be hypotensive (but no blood pressures were recorded in the transfer medical record). He was resuscitated with intravenous saline and underwent endotracheal intubation. Past Medical History On arrival at our hospital, further history revealed that the patient had a truncal rash for more than 20 years. He had two previous syncopal episodes associated with delirium, hypotension and respiratory failure. None of these episodes had any clear precipitating event. After the first event, two years previously, a cardiac evaluation resulted in coronary artery bypass surgery. He also had a history of type 2 diabetes mellitus and was taking glipizide and …
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