History of Present Illness:
A woman in her early 30’s with a history of endometriosis and recent travel presents to the ER with 11 days of shortness of breath and left-sided pleuritic chest pain that radiates to her back and is also worse when she swallows. She denies sore throat but has been having low-grade temperatures in the 99’s. She took 5 days of doxycycline has not helped and her symptoms have continued to progress. No other complaints. No leg pain or swelling. No family history of blood clots. No risk factors for aspiration.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is also normal
Imaging:
What is the most likely diagnosis?
- A) PE
- B) Pulmonary endometriosis
- C) Fungal pneumonia
- D) Viral pneumonia
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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QUIZ ANSWER:
- A) PE – good thought but unlikely with this imaging results
- B) Pulmonary endometriosis – good thought
- C) Fungal pneumonia – CORRECT
- D) Viral pneumonia – not usually this focal
1-Minute Consult on this topic: Click HERE and go to page 148
CASE CONCLUSION: Started on antibiotics, which were stopped once serology came back positive for Cocci (IgG normal but IgM elevated signifying an acute infection). Within about a week she gradually improved without further treatment. Her recent travel had been to an area where Cocci was endemic to see her husband who was stationed near Fresno, CA.