A 60-year-old female presented to the emergency department (ED) with a chief complaint of bilateral lower extremity swelling. She first noticed the swelling three months earlier and felt it was gradually worsening. The swelling initially started in her legs and abdomen but then progressed to her face. She denied any associated pain in her legs but reported that they felt heavy. She denied associated orthopnea, cough, or shortness of breath. She denied any change in activity tolerance but did report a decline in her daily activities due to social distancing because of coronavirus 2019. She also described chronic, brown loose stools over the past year, which were unrelated to her diet. She had loose stools daily, which were not particularly malodorous and not associated with abdominal pain. She also noted non-bloody, non-bilious emesis intermittently over the prior year without any clear, identifiable triggers. She had a remote history of vomiting in the past with panic attacks; so she attributed her vomiting to anxiety. She also noted a 15-pound weight loss during the preceding year, which she attributed to not eating regular meals throughout the day coupled with her persistent vomiting. She denied fevers, chills, night sweats, or chest pain. Her past medical history included a recent diagnosis of a heart murmur one year earlier. She also had a history of anxiety, panic attacks, depression, an eating disorder (low-baseline caloric intake), and psoriasis. She was previously on fluoxetine and hydroxyzine but took herself off several years earlier as she felt they were not working. She was no longer taking any medication at the time of presentation. She was post-menopausal and had irregular periods prior to menopause. She had no children and had never been pregnant. Vital signs were as follows: temperature 38.4° Celsius, heart rate 140 beats per minute (bpm), blood pressure 120/80 millimeters of mercury, respiratory rate 27 breaths per minute (rpm) and room air oxygen saturation 100%. Her body mass index was 27. Her physical exam was notable for a well-developed female who appeared tired and uncomfortable. Her head, eyes, ear, nose, and throat exam was significant for facial swelling and pupils that were midrange, equal, round, and reactive to light bilaterally. She had moist mucous membranes and no lymphadenopathy or palpable masses. On cardiac exam she had a harsh 4/6 blowing systolic murmur that was loudest at the left sternal border but also auscultated through her back. She was tachypneic but had clear lung sounds. Her abdomen was distended with a fluid wave and dullness to percussion but was nontender. Her extremities were notable for 3+ pitting edema from her feet to her bilateral upper thighs. No upper extremity edema was present. On neurologic exam she had no focal deficits. She was awake, alert, and oriented to person, place, and time. Her skin was warm and dry. Her initial laboratory results () showed multiple abnormalities. An electrocardiogram (ECG) was performed (). A computed tomography (CT) of her abdomen and pelvis with intravenous (IV) contrast was also obtained (). The patient was initially treated with IV fluids and piperacillin-tazobactam due to concerns for sepsis with her fever and tachycardia. She acutely worsened after administration of fluids. She subsequently was placed on non-invasive ventilation and was administered IV furosemide. A test was then ordered, and a diagnosis was made.