Cold case: Bedside diagnosis of Mycoplasma pneumonia

✍ Scribed by Sally Daganzo; Sott Bratman

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 173 KB
• Volume: 5
• Category: Article
• ISSN: 1553-5592
• DOI: 10.1002/jhm.699

✦ Synopsis

A 35-year-old woman with no past medical history presented to the Emergency Department (ED) with 3 weeks of worsening cough and shortness of breath. Two weeks prior to her presentation she was seen by her primary care physician for flu-like symptoms, including myalgias, subjective fevers, nonproductive cough, and malaise. She was told that her symptoms were attributable to influenza, and she was treated supportively; however, her symptoms progressed, and she was referred to the ED for further care. Of note, she reported recent cross-continental air travel as well as an upper respiratory illness in her young child.

On physical exam she was afebrile with normal vital signs and normal room air oxygen saturation. Her oropharynx was clear, and she had no sinus tenderness, rashes, joint swelling, or palpable lymphadenopathy. She was in moderate respiratory distress and had inspiratory crackles at both lung bases.

Complete blood count, electrolytes, and electrocardiogram (ECG) were within normal limits. A D-dimer level was slightly elevated. Chest X-ray showed a mild hazy opacity at the right lung base (Figure 1). Computed tomography (CT) angiography of the chest showed bilateral lower lobe infiltrates (Figure 2) but no pulmonary emboli.