Case Report

A 59 year old gentleman with a past medical history ofhypertension, hyperlipidemia, anxiety, depression, arthritis,and hypothyroidism presented with a five day history of feverto 102º F. He complained of a three-day history of nausea,vomiting, and non-bloody, loose diarrhea, all of which hadbeen persistent and worsening over the past week. Over thepast two days, the patient had felt short of breath, and presentedin a state of severe dyspnea. He had experienced an indolentcourse of illness, but was now concerned with his tachynpea andwheezing, and he had developed a productive cough with a smallamount of yellow-brown sputum. He denied any hemoptysisas well as recent travel or sick contacts. On admission, thepatient was taking hydrochlorothiazide, lisinopril, atorvastatin,levothyroxine and fluoxetine. He was also using over-thecounteribuprofen for arthritic pain.

The patient was a smoker with a ten pack-year history. Hedenied intravenous drug use and occasionally drank alcohol.Family history was significant for paternal obstructive lungdisease and coronary artery disease. On review of systems, thepatient denied having a sore throat or any nasal congestion.