A 19-Year-Old Woman With Fever, Cough, and Dyspnea at Rest

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians, but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please email us at ccsuggestions@medscape.com with the subject line "Case Challenge Suggestion." We look forward to hearing from you.

Background

A 19-year-old White woman with no relevant past medical problems presents to the emergency department (ED) with high-grade fever with chills, cough, and dyspnea at rest. Her symptoms have been ongoing for 1 week. She works at a medical office as a receptionist and initially thought she contracted something from one of the patients. However, her symptoms were not getting better, so she decided to come to the ED for evaluation. She denies any recent travel to high-risk countries, has no pets at home, nor has had exposure to smoke or chemicals. Patient takes no medications other than birth control pills and has been otherwise healthy.

Her parents both have well-controlled diabetes and no other medical issues. Her older sister has asthma, for which she uses an albuterol inhaler. She has no prior hospitalizations, and she has been up to date on all her vaccinations.

Prior to coming to the ED, she sought help at an urgent care for her symptoms and she was prescribed a azithromycin for 5 days that she has finished but had no improvement of symptoms. No imaging was performed at the urgent care. Her fever ranges from 100 °F to 101 °F, and her cough is not productive. She has used ibuprofen and acetaminophen to control her fever. She has felt slightly short of breath since her illness began, but this morning, her shortness of breath was the most distressing symptom and she decided to come to the ED for further evaluation.

On arrival in the ED the patient's heart rate was 120 beats/min, respiratory rate was 26 beats/min, body temperature was 102.9 °F, and her oxygen saturation was 90% on room air. On physical exam, there were diminished breath sounds bilaterally, but it was otherwise unremarkable. She was started on supplemental oxygen at 6L/min, 650 mg of acetaminophen, and 1L of normal saline fluid bolus.

A chest radiograph revealed bibasilar pneumonia. Due to concern for pulmonary embolism (PE), a CT of the chest with contrast was done that showed bibasilar consolidation and interlobular septal thickening with diffuse ground glass opacities especially in the bases (Figure 1). Per protocol, she was started on respiratory isolation and a swab for SARS-CoV-2 was sent.

Figure 1. Bilateral interlobular septal thickening with mild diffuse ground glass opacities and subtle ill-defined nodular densities.

Medscape © 2024 WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Neeladri Misra. A 19-Year-Old Woman With Fever, Cough, and Dyspnea at Rest - Medscape - Jun 25, 2024.