History of Present Illness:
A woman in her early 30’s with a history of endometriosis and recent travel presents to the ER with 11 days of shortness of breath and left-sided pleuritic chest pain that radiates to her back and is also worse when she swallows. She denies sore throat but has been having low-grade temperatures in the 99’s. Her doctor prescribed a Z-pack but that has not helped and her symptoms have continued to progress. She denies any leg pain or swelling of other symptoms.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is also normal with no rales or wheezes or even rhonchi
Testing: her WBC was 13 and D-dimer 1,200. Her CXR and CT are shown below
What is the most likely diagnosis?
- A) Pulmonary embolism
- B) Pulmonary endometriosis
- C) Bacterial pneumonia
- D) Fungal pneumonia
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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QUIZ ANSWER:
- A) PE – good thought but unlikely with this imaging results
- B) Pulmonary endometriosis – good thought
- C) Bacterial pneumonia – good thought as there is a lot of azithromycin resistance
- D) Fungal pneumonia – CORRECT
1-Minute Consult on this topic: Click HERE and go to page 148
CASE CONCLUSION: Started on antibiotics, which were stopped once serology came back positive for Cocci (IgG normal and IgM elevated signifying an acute infection). Within about a week she gradually improved without further treatment. Her recent travel had been to an area where Cocci was endemic to see her husband who was stationed near Fresno, CA.