Monday, August 28, 2006

35 year old with cough, chills

35 year old without PMhx except a MVA 5 years ago, anxiety and depression. Now with chills and subjective fever and weight loss for the past few months. Meds: Paxil. Fhx: brother died of liver failure, patient does not know etiology. SH denies IVDA. 2 PPD x 20 years. Quit 5 yrs ago. HIV negative. Exam Afebrile. VSS. Some decr breath sounds upper lung zones b/l. WBC 11.

What would you do next?

2 comments - CLICK HERE to read & add your own!:

Baleeiro said...

Nice air-fluid level. Looks like a pulmonary abscess. I'd start treating and try and get sputum samples.
Incidentally, he already has emphysematous changes(!) and I would have a low threshold for a bronch if I didn't start seeing some radiographic changes as lung Ca's can cavitate and get superinfected.

Jennings said...

We treated him with antibiotics for infected bulla and will repeat a CT in 6 weeks. Agree regarding the emphysematous changes in a 35 year old smoker. What was more interesting was that his brother dies early from cirrhosis. But alas, the patient's alpha 1 AT level was 200....