Case Report

A 19-year-old man with no past medical history presented tothe ER with a sore throat, cough, and pleuritic chest pain. Thepatient had been well until 1 month before admission, whenhe developed a sore throat and felt ill. He presented to theemergency department twice for these symptoms. On the first visit, the patient had a positive rapid strep test. He was diagnosedwith strep throat and treated with penicillin IM. However, hissore throat persisted. Five days before admission, the patientdeveloped a non-productive cough. One day prior to admissionhe developed severe right sided chest pain that was throbbing,pleuritic, and radiated to his right shoulder. The pain, whichwas initially relieved by sitting forward and with Ibuprofen,continued to worsen, prompting the patient’s mother to bringhim back to be re-evaluated.

Upon presentation, the patient denied shortness of breath, fevers,or chills. He had no personal history of prenatal or childhooddisease, and denied family history of early heart disease, lungdisease, cancer or bleeding disorders. He denied tobacco,alcohol, or illicit drug use. He reported being heterosexual with4-5 lifetime sexual partners, and one new partner in the priortwo months.