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Step 1: View clinicals

A 58 year old man presents with a high fever, headache, sweating, arthralgia and myalgia for 9 days. He also complains of a non-productive cough and mild dyspnea for 2 days. His medical history includes stable ischaemic heart disease and dyslipidemia for 5 years, for which he is on atenolol and simvastatin therapy. He owns a pet shop selling parrots, parakeets, and budgerigars. There is no history of recent travel, intravenous drug use or blood transfusion.

Step 2: Order all relevant investigations

Portable Chest X-Ray

The chest X-Ray shows extensive consolidation of the right upper and left lower lobes.

Full Blood Count

WBC: 17,400/mm3 (5,000-10,500) N: 93% HB: 13.9 g/dL (12-18.5) Plt: 160,000/mm3 (150,000-400,000)

Arterial Blood Gases

pH: 7.24 (7.35-7.45) PO2: 42 mmHg on FiO2 60% (> 100) PCO2: 38 mmHg (35-45) HCO3-: 16 mmol/L (22-28) Base excess: - 8.9mmol/L (-2 to +2)

Sputum Induction

Several sputum samples are collected. ELISA for Mycoplasma pneumoniae, Klebsiella pneumoniae, Legionella pneumophila are negative. PCR is positive for Chlamydophila psittaci. Preliminary culture results: no growth.

Step 3: Select appropriate management

IV Fluids Stat
IV Doxycycline
Intubation & Ventilation

Score: ★★☆