Cyprian is a 22 year-old woman with a cough and chronic and diarrhea.

Brought by her family for evaluation. Ill appearing, cachectic woman. Dyspnea and non-productive cough. Loose, non-bloody stools for two months. Lethargy and anorexia for several months. Married, does not drink or smoke. No significant past medical history. Vital signs: T = 37.4°C, P = 100, BP = 90/60, R = 28

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She is seen on rounds the morning after being admitted:

• Cyprian is lethargic and displays a flat affect.
• She has pale conjunctiva, oral thrush and small non-tender cervical adenopathy.
• Lung sounds are course bilaterally.
• She has an early systolic ejection murmur.
• There is mild generalized abdominal tenderness without rebound or guarding.
• Neurological and extremity exams are unremarkable.

Surprisingly, her hemogram and chest X-ray, order the day before, are back.