Conclusions

Large-volume EVG/COBI/FTC/TAF ingestion may be followed by delayed hemodynamic and cardiopulmonary deterioration despite an initially reassuring presentation. In this case, shock requiring vasopressor support, acute hypoxic respiratory failure, metabolic acidosis, QTc prolongation, and reduced left ventricular systolic function developed over the first 24 hours. Although quantitative drug concentrations and baseline cardiac imaging were unavailable, limiting causal attribution to the ingestion or a specific component, this case expands the limited literature describing severe toxicity after EVG/COBI/FTC/TAF self-poisoning. Clinicians should consider close observation for delayed deterioration after large-volume ingestion, particularly when early clinical findings are reassuring.