Discussion
We followed the second course and discontinued the antibiotics. The overall clinical picture, including the serial low procalcitonin levels, suggested RSV pneumonia. If bacterial pneumonia had seemed likely, then 5 days of therapy would be as effective as a longer course.[3]Given the myriad safety warnings, fluoroquinolones should be reserved for situations in which other agents cannot be used.[4] Although it could be argued that empirical coverage should have included Pseudomonas aeruginosa and MRSA, the negative sputum culture ruled out those pathogens. This patient improved and was discharged home a week later.
'Allergic to Penicillin'
A 64-year-old woman seen in the ED had a 4-day history of fever, chills, body aches, and cough, during which she was seen at urgent care. Testing for influenza was reportedly negative, and a chest x-ray "showed pneumonia." She was prescribed azithromycin, which she had been taking for 2 days before this admission, but was not improving. She reported no recent travel or sick contacts, and she is reportedly allergic to penicillin.
Upon arrival, her temperature was 102°F and her oxygen saturation on room air was 94%. A WBC count was 4700 cells/µL (with 15% bands). The procalcitonin level was 0.19 ng/mL. Polymerase chain reaction (PCR) assays for influenza A and B were negative. A chest x-ray revealed a consolidative left lower-lobe infiltrate (Figure 2).
Figure 2. Chest x-ray showing left lower-lobe infiltrate. Image courtesy of Neil Gaffin, MD.
The patient was started on aztreonam and doxycycline and admitted to a general medical floor. Respiratory pathogen testing the next day revealed adenovirus, and a repeat procalcitonin level was 0.19 ng/mL.
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Cite this: We Often Get CAP Wrong: Case Challenges - Medscape - Jun 13, 2019.
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