A 29-year-old IV heroin abuser is admitted to the Emergency department with a severe cough, fever and rigors. He says that he has suffered progressively increasing shortness of breath on exertion over the past few days. On examination he has a pyrexia of 37.9oC, he has a BP of 122/75 mmHg and a BMI of 17. There are mild crackles and wheeze on auscultation of the chest. Investigations; Hb 10.9 g/dl WCC 6.1 x109/l PLT 245 x109/l Na+ 141 mmol/l K+ 4.0 mmol/l Creatinine 130 μmol/l LDH 420 U/l (70-250) Sats 92% on air, 89% after walk test CXR Diffuse bilateral infiltrates Which of the following is the most likely diagnosis? Tuberculosis Endocarditis Klebsiella pneumoniae pneumonia Pneumocystis jiroveci pneumonia Staphylococcus aureus pneumonia
Posted on: Thu, 17 Jul 2014 12:41:21 +0000
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