Gordon H. Sun, MD, MS

April 29, 2014

Case Challenge 3: Community-Acquired Pneumonia

A 40-year-old accountant presents to his family physician with a 5-day history of low-grade fever, chills, productive cough, and pleuritic chest pain. He believes he may have "picked up something" from sick colleagues at the office where he works.

The patient is otherwise healthy, with no known history of cardiopulmonary disease or diabetes mellitus. The last time he used antibiotics for any kind of infection was many years ago. He is a nonsmoker and consumes no more than 2-3 beers a month. He has no known allergies.

On presentation, his temperature is 101.2°F (38.4°C), heart rate is regular at 95 beats/min, respiratory rate is 20 breaths/min, and blood pressure is 125/80 mm Hg. He appears nontoxic and is cooperative with examination.

Notably, the patient has a continuous cough associated with green-yellow sputum and some right-sided pleuritic chest pain, but no stridor is appreciated. No rhinorrhea is noted, and the oropharyngeal examination is normal. He has no cervical, supraclavicular, or axillary lymphadenopathy.

On chest examination, rales and crackles can be heard on auscultation. He has dullness to percussion at the right lung base. No murmurs are noted. Abdominal examination is normal.

Point-of-care complete blood count and arterial blood gas testing demonstrated a white blood cell count of 16.5 cells/µL with left shift, but otherwise no other abnormalities. Chest radiography demonstrated lobar consolidation in the right lower lobe. The patient was diagnosed with CAP.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.