Case Study: Diagnosing pneumonia mimics

Introduction

Pneumonia has been recognized by the medical profession since ancient times. It is one of the leading causes of infectious deaths in the West and cause of considerable mortality and morbidity in our part of the world. Diagnosis is mostly based on history, clinical findings, and X-rays. Exact proof of infection and the ability to isolate the organism from blood and sputum culture is only available in less than half of the cases we see. Empirical treatment is begun on patients after sending the necessary microbiology samples, depending upon the regional antibiotic sensitivity or antibiotic policy.

Background

A 34-year-old male came in with a high-grade fever. He initially had a cough, but that had subsided. He was admitted to another hospital for one week and received antibiotics. He experienced no shortness of breath or chest pain. Upon examination, though he was febrile, he was in good general condition, and his vitals were stable. Examination of his respiratory system showed normal breath sounds and resonant percussion notes on left chest, but right lower chest had decreased breath sounds and was dull in percussion resonance. Other systems were normal. His chest X-ray is shown below.

pneumonia mimic 1 - kasim

Blood routine, urea, and creatinine levels were normal. Sputum culture did not grow anything. The patient was screened for dengue, leptospira and malaria.

We performed a chest ultrasound; the report showed no significant fluid, mostly consolidation. The patient was put on another set of antibiotics and continued to be febrile for the next four days. Finally, we decided to do a chest CT scan....

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This entry was posted in Case Studies, Respiratory and tagged . Volume: .

2 Comments

  1. ravikumar bhaskaran
    Posted Jan 2014 at 2:22 pm | Permalink

    Yes, it can be only drug fever. But the problem faced by a general physician like me is that the relatives as well as the patient will harp on the symptom of FEVER even if I tell them that it is better to have fever and not to reduce it by fourth hourly paracetamol. The practical difficulty is that even in our Medical College Trivandrum paracetamol is given on a fourth hourly basis. So the pattern of the fever cannot be ascertained.
    my mail I.D.:bhaskaran.ravikumar@gmail.com

  2. surya prakash
    Posted Jan 2015 at 3:42 pm | Permalink

    I suggest that CBC may be very helpful in diagnosing bacteria pneumonia,leucocytosis is common in bacterial pneumonia while it is normal or leucopenia in viral cases. Simple GBP is very informative.

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