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A 73-year-old woman was transferred to this hospital because of worsening pneumonia, increasing hypoxia, and azotemia.
She had been well until 17 days before admission, when nonbloody diarrhea and fatigue began. The diarrhea resolved five days later, but the fatigue persisted, with lethargy that worsened for several days. Seven days before admission, the diarrhea recurred and was accompanied by vomiting, chills, fever, lower abdominal cramps, diffuse myalgia, and a frontal headache. There was no cough, dyspnea, chest pain, or hemoptysis. She was taken to another hospital.
When the patient arrived at the other hospital, the temperature was 38.7°C, the pulse
Differential Diagnosis
Typical Pneumonias
Atypical Pneumonias
Legionnaires' Disease
Acute Respiratory Distress Syndrome and Bronchiolitis Obliterans with Organizing Pneumonia
Summary
Clinical Diagnosis
Dr. Aaron B. Waxman's Diagnosis
Pathological Discussion
Anatomical Diagnosis
Source Information
From the Pulmonary and Critical Care Unit (A.B.W.), the Division of Thoracic Radiology (J.O.S.), and the Department of Pathology (E.J.M.), Massachusetts General Hospital; and the Departments of Medicine (A.B.W.), Radiology (J.O.S.), and Pathology (E.J.M.), Harvard Medical School — both in Boston.
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