CASE PRESENTATION —Charles T. Bingham III, MD A 27-YEAR-OLD man was transferred to The Johns Hopkins Hospital for evaluation of delirium. Five days prior to admission he had presented to another hospital with hematemesis and syncope. Esophagogastroduodenoscopy revealed the presence of a 0.5-cm gastric ulcer. The hematocrit value and the platelet count were low. The patient was treated with packed red blood cells (RBCs) and platelets. During the next few days, he developed agitation, confusion, and hallucinosis and was transferred to The Johns Hopkins Hospital. His past medical history was remarkable for alcoholic hepatitis. The patient drank a minimum of one pint of rum plus large volumes of wine daily. He denied taking any medications. On physical examination, the patient's temperature was 38.9°C; blood pressure, 128/86 mm Hg; pulse rate, 96 beats per minute; and respirations, 24/min. The sclerae were icteric. The liver and spleen were not enlarged, and the