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A 43-year-old man was admitted to the hospital because of fever and rapid deterioration of vision in the left eye.
The patient had been well until six weeks earlier, when fevers, sweats, myalgias, and right-sided pleuritic chest pain developed. Three days later, a chest radiograph reportedly showed pneumonia in the right lower and middle lobes. A five-day course of azithromycin was prescribed. He felt better with treatment, but one day after the course of medication ended, he felt worse. Twenty-six days before admission, a repeated chest radiograph revealed a right-sided pleural effusion. He refused to undergo thoracentesis or to be
Differential Diagnosis
Pneumonia
Complications of Pneumonia
Endocarditis due to Streptococcus pneumoniae
Clinical Diagnosis
Dr. Robert H. Rubin's Diagnoses
Pathological Discussion
Anatomical Diagnosis
Source Information
From the Division of Infectious Disease, Brigham and Women's Hospital, Boston (R.H.R.); the Center for Experimental Pharmacology and Therapeutics, HarvardMIT Division of Health Sciences and Technology, Cambridge, Mass. (R.H.R.); the Departments of Medicine (R.H.R.), Pediatrics (M.E.K.), and Pathology (E.J.M.), Harvard Medical School, Boston; and the Departments of Pediatrics (M.E.K.) and Pathology (E.J.M.), Massachusetts General Hospital, Boston.
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