Reviewed By Allergy, Immunology & Inflammation Assembly
Submitted by
Adam G. Manko MD
Fellow/Clinical Instructor
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine
The Ohio State University Wexner Medical Center
Columbus, OH
Konstantin Shilo, MD
Associate Professor
Department of Pathology
The Ohio State University Wexner Medical Center
Columbus, OH
Jennifer W. McCallister MD
Associate Professor of Clinical Medicine
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine
The Ohio State University Wexner Medical Center
Columbus, OH
Submit your comments to the author(s).
History
A 35 year-old African-American man presented from prison in southwestern Ohio with two weeks of shortness of breath, productive cough with yellow sputum, daily fevers, drenching sweats, unintentional weight loss of 20 pounds, and malaise. He had been incarcerated for 4.5 years, and had not left the prison during that time. He denied tuberculosis exposure or history of a positive purified protein derivative (PPD). He noted several inmates recently diagnosed with pneumonia. It was notable that the outdoor yard at the prison had many pigeons.
His past medical history was significant only for a testicular abscess. His social history was positive for smoking three cigarettes daily since the age of 15. He had no family history of pulmonary disease or malignancy. He did not take any prescription or over the counter medications, and had no known drug allergies.
Physical Exam
Lab
Significant Laboratory data
White Blood cells | 22.5 k/uL | (4.5-11.0 k/uL) |
Hemoglobin | 11.9 g/dL | (13.2-17.3 g/dL) |
Hematocrit | 36.7 % | (39.0-49.0%) |
Platelets | 565 K/uL | (150-400 K/uL) |
Differential 81.4% neutrophils, 2% band, 5.3% lymphocytes, 8.6% monocytes
Sodium | 129 mmol/L | (133-143 mmol/L) |
Streptococcus pneumonia urinary antigen – negative
Legionella urinary antigen – negative
Blood cultures – negative
Urine culture – negative
Figures
Figure 2: Computed Tomography (CT) of the chest demonstrated diffuse micro-nodular infiltrates throughout both lung fields without associated lymphadenopathy
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