A Man with Acute Severe Pneumonia: Case Discussion from the University of Louisville Hospital

Dr.Viswanathan Nagarajan (Infectious Diseases fellow): A 39-year-old previously healthy male presented to the emergency room for sudden onset left sided chest pain, cough with blood tinged sputum and shortness of breath, which started abruptly six hours prior to the presentation. He had been to another emergency room three days prior with myalgia, fever, headache, nausea, vomiting and diarrhea. Rapid influenza screen had been negative at that hospital. Nevertheless, he was discharged on oseltamivir. Now, shortness of breath was at rest and the chest pain was associated with cough and deep breathing. He also continued to have diarrhea and vomiting. Apart from having a 27 pack-year history of smoking, marijuana use and consuming a pint of alcohol every day, he had no history of intravenous drug use. He lived with his girlfriend, and denied promiscuous sexual activity or sex with males. He denied any travel outside of the US, or having pets at home. He had no known drug allergies. His temperature was 38.8° Celsius, heart rate 130 beats/min, respiratory rate 33 breaths/min, blood pressure 151/83 mm Hg, and oxygen saturation 93% on room air (FiO2 21%). The patient was in moderate respiratory distress and was seen using accessory muscles of respiration. He was alert, but unable to speak up as his voice was feeble. He had no signs of clubbing or generalized lymphadenopathy. No needle tracks were observed. Lung auscultation revealed equal air entry on both sides with no changes in his inspiration to expiration ratio. Bilateral crackles and wheezing were noted on the entire left side. On percussion, no dullness or resonance was noted.