A 69-year-old male presenting with hypotension and anasarca

A 69-year-old Caucasian male with a past medical history remarkable for hypertension and testicular non-Hodgkin's lymphoma (NHL) presented to the emergency department with a 1-week history of fatigue and new onset lower extremity edema. For the past 8 months, the patient was having a nonproductive cough. Work up by his primary care physician was negative, and the patient was switched from enalapril to losartan 1 week before presentation. The cough resolved, however, 2 days later the patient began to experience fatigue and lightheadedness that persisted despite decreasing the dose of losartan. He continued to develop lower extremity edema and was again seen by his primary care physician who noted the patient to be hypotensive. He was referred to the emergency department for evaluation.