Case 79

1. Presented by Seena Tabibi MD
Reviewed by Karen Carroll MD

An adult patient presented to the Emergency Department with fever, watery diarrhea, confusion, headache, dry cough, and generalized weakness. The symptoms began three days prior to presentation. Past medical history is significant for extensive tobacco use. However, the patient recently quit smoking several weeks prior to presentation. The patient has not had any recent hospitalizations and does not have any sick contacts. On presentation vital signs are as follows:

Temperature 39.4° Celsius
Respirations: 18/minute
Heart Rate: 86 beats/minute
Pulse Oximetry: 94%
Blood Pressure: 114/74 mmHg

Physical Examination revealed decreased breath sounds in the right lower lobe with mild nonspecific tenderness to palpation over the abdomen. The heart rhythm was regular. No other abnormalities were noted.

Chest X-ray revealed right-sided peri-hilar infiltrates with no evidence of pleural effusion or pneumothorax. Computed Tomography supported the chest X-ray findings by demonstrating right lower lobe consolidation.

Laboratory Studies are as follows:

White Blood Cell Count: 14.53 K/cu mm (Reference 4.50-11.00 K/cu mm)
Absolute neutrophil count: 12.64 K/cu mm (Reference: 4.50-11.00 K/cu mm)
Pro-calcitonin: 6.42 ng/mL (Reference: less than 0.10 ng/mL)
Sodium: 137 meq/L (Reference: 135-148 meq/L)
Creatinine: 1.6 mg/dL (Reference: 0.5-1.4 mg/dL)
C-reactive protein: 24.0 mg/dL (Reference: 0.0-0.5 mg/dL)

Which of the following is the most likely diagnosis?

 

14 thoughts on “Case 79”

  1. I love what you guys are usually up too. This type of clever work and exposure! Keep up the great works guys I’ve included you guys to my own blogroll.

  2. I wanted to take a moment to express my deepest gratitude for the invaluable knowledge I’ve gained from this website. It has broadened my understanding and empowered me to pursue my goals.Your dedication is truly commendable. The information provided is presented in a clear and concise manner, making it easy to understand and apply. It has become an invaluable resource for me, and I appreciate the effort put into creating such a fantastic platform. See ya! ID : CMT-ORN5T6S04EMS9K9TV5

Leave a Reply

Your email address will not be published. Required fields are marked *