Patient with URI and Lobe Lesion on Chest X-Ray

​BY MARGARET MARY S. LANDEL, DO; & CARLA DUGAS, DOA 59-year-old otherwise healthy man presented with an upper respiratory illness of four weeks' duration. His initial presentation to his primary care physician one month prior included a nonproductive cough and low-grade fever, which lasted approximately two weeks until his internist ordered a chest x-ray. That showed a 3 cm well-circumscribed right lower lobe lesion, and was followed by a contrast enhanced chest CT. The chest CT was concerning for pulmonary neoplasm, and he received an interventional radiology-guided biopsy of the lesion. Results were still pending at the time of ED presentation.​The patient's primary care physician had prescribed a seven-day course of Levaquin for presumed community-acquired pneumonia (CAP) before he presented to the ED. The patient's fever remained elevated after day three, and he began to worsen, at which point he was switched to clindamycin.The patient had had a prior total thyroidectomy for thyroid carcinoma as well as previously being diagnosed with hyperlipidemia and benign prostatic hypertrophy. His medications include Synthroid, Avodart, Lipitor, and clindamycin. Social history was negative for tobacco or alcohol. He was currently training for the Ironman competition and was an avid runner and CrossFit member. He had traveled to Jamaica three months earlier and to Loredo, TX, two weeks prior to his ED visit.His initial vitals at presentation were blood pressure of 112/84 mm H...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research