Case history

Case history

A 54-year-old smoker with multiple comorbidities (diabetes, hypertension, coronary artery disease) presents with a 2-day history of a productive cough with yellow sputum, chest tightness, and fever. Physical examination reveals a temperature of 38.3°C (101°F), BP of 150/95 mmHg, heart rate of 85 bpm, and a respiratory rate of 20 breaths per minute. His oxygen saturation is 95% at rest; lung sounds are distant but clear, with crackles at the left base. Chest x-ray reveals a left lower lobe infiltrate. 

Other presentations

Pneumonia can occur at any age, but the incidence increases significantly in old age, and pneumonia is a leading cause of illness and death in older patients. The clinical manifestations of pneumonia in elderly persons are often less intense than those in younger patients.[2] Atypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumophila, and respiratory viruses can present in a subacute fashion with gradual onset of fever, non-productive cough, constitutional symptoms, relatively normal white blood cell count, and absent or diffuse findings on lung examination.[3] Patients with severe pneumococcal or Legionella pneumophila pneumonia often progress rapidly to respiratory failure.

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