Jessica Galant-Swafford1, Matthew Light2, Mark W Onaitis3, Stephen A Rawlings4, Joshua Fierer4, Judd W Landsberg2. 1. Medicine Service, Internal Medicine Section, Veterans Affairs Medical Center, La Jolla, CA; Department of Medicine, Division of General Internal Medicine, University of California San Diego School of Medicine, San Diego, CA. Electronic address: jgalantswafford@ucsd.edu. 2. Pulmonary, Critical Care, and Sleep Medicine Section, Veterans Affairs Medical Center, La Jolla, CA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego School of Medicine, San Diego, CA. 3. Surgery Service, Cardiothoracic Surgery Section, Veterans Affairs Medical Center, La Jolla, CA; Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of California San Diego School of Medicine, San Diego, CA. 4. Infectious Diseases Section, Veterans Affairs Medical Center, La Jolla, CA; Division of Infectious Diseases, University of California San Diego School of Medicine, San Diego, CA.
Abstract
CASE PRESENTATION: A 37-year-old man with poorly controlled type 2 diabetes presented with severe right-sided pleuritic chest pain, respiratory splinting, and cough. Two weeks earlier, he had been evaluated at an urgent care for cough and was prescribed a 5-day course of azithromycin for bronchitis. He then presented to our ED reporting mild, right-sided pleuritic chest pain. Vital signs were normal, and his chest radiograph showed a trace right pleural effusion (Fig 1A). He was discharged with naproxen for pleurisy. Three days later, he returned, reporting a dramatic increase in the severity of his pleuritic chest pain and a cough that had become productive of yellow-brown sputum. He denied fever, but endorsed chills and night sweats. His medications included atorvastatin, lisinopril, metformin, and saxagliptin. His parents were from Guam, although he was born and raised in San Diego, CA. He was employed as a social worker and denied any history of cigarette smoking, alcohol, or drug use.
CASE PRESENTATION: A 37-year-old man with poorly controlled type 2 diabetes presented with severe right-sided pleuritic chest pain, respiratory splinting, and cough. Two weeks earlier, he had been evaluated at an urgent care for cough and was prescribed a 5-day course of azithromycin for bronchitis. He then presented to our ED reporting mild, right-sided pleuritic chest pain. Vital signs were normal, and his chest radiograph showed a trace right pleural effusion (Fig 1A). He was discharged with naproxen for pleurisy. Three days later, he returned, reporting a dramatic increase in the severity of his pleuritic chest pain and a cough that had become productive of yellow-brown sputum. He denied fever, but endorsed chills and night sweats. His medications included atorvastatin, lisinopril, metformin, and saxagliptin. His parents were from Guam, although he was born and raised in San Diego, CA. He was employed as a social worker and denied any history of cigarette smoking, alcohol, or drug use.
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