A 34-year-old male presents with progressively worsening dyspnea leading to intubation and mechanical ventilation. His symptoms started a week ago, when he initially had fever, headache, myalgia, nausea, and vomiting, then developed dyspnea on day five. He recently returned from a camping trip in Colorado where he stayed in a wood cabin.
A chest-ray shows bilateral diffuse interstitial infiltrates resembling acute respiratory distress syndrome (ARDS). Laboratory testing shows bandemia, thrombocytopenia, hemoconcentration, and a peripheral blood smear reveals the cells seen here.