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Dr. Peter P. Moschovis (Medicine and Pediatrics): A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal insufficiency, diabetic ketoacidosis, and hypotension.
The patient was in his usual state of health, with chronic respiratory problems, until approximately 2 months before admission, when increasing fatigue, somnolence, and intermittent mild confusion developed, associated with diarrhea and decreasing glycemic control. Three weeks before admission, he was admitted to another hospital because of increasing orthopnea and paroxysmal nocturnal dyspnea. On examination, there were crackles in the bilateral midlung fields. The serum
Differential Diagnosis
Transplant Recipients and Possible Infections
Community-Acquired Infections
Post-Transplantation Infections in Chronically Ill Patients
Post-Transplantation Malignant Conditions
Approach to Diagnosis
Summary
Clinical Diagnosis
Dr. Lindsey R. Baden's Diagnosis
Pathological Discussion
Anatomical Diagnosis
Source Information
From the Division of Infectious Disease, Brigham and Women's Hospital (L.R.B.); the Departments of Radiology (S.R.D., A.S.R.G.) and Pathology (J.A.B.), Massachusetts General Hospital; and the Departments of Medicine (L.R.B.), Radiology (S.R.D., A.S.R.G.), and Pathology (J.A.B.), Harvard Medical School.
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