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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 345:1627-1634 November 29, 2001 Number 22
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Case 37-2001— A 76-Year-Old Man with Fever, Dyspnea, Pulmonary Infiltrates, Pleural Effusions, and Confusion
Sigal Yawetz, M.D., and Eugene J. Mark, M.D.

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Presentation of Case

A 76-year-old man was admitted to the hospital because of atrial fibrillation and increasing dyspnea.

The patient had been well until three weeks earlier, during an unseasonably warm period in late autumn, when a nonproductive cough without fever developed. Nine days later, the cough became productive, although the patient remained afebrile. Azithromycin was prescribed, but fever and chilliness developed, with nausea, vomiting, anorexia, mild bitemporal headache, and abdominal pain. He stopped taking the azithromycin after four days.

Three days before admission, the patient went to a local hospital, where the temperature was 37.9°C and conjunctival injection was noted. The white-cell . . . [Full Text of this Article]

Differential Diagnosis

Sexually Transmitted Diseases

Commonly Acquired Pneumonia with Systemic Manifestations

Diseases Endemic on Nantucket

Clinical Diagnosis

Dr. Sigal Yawetz's Diagnosis

Pathological Discussion

Anatomical Diagnosis

References


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