What's Your Diagnosis? Community-Acquired Pneumonia in the ED

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department right.

Case Presentation: Community-Acquired Pneumonia in the Emergency Department

A 30-year-old man with no significant medical history presents to the ED with 2 days of fever, cough productive of green sputum, and malaise…

Examination reveals left-sided rhonchi that do not clear with cough.
The patient has a heart rate of 105 beats/min and a temperature of 39.1°C. He is normotensive and hasa 95% oxygen saturation on room air.
Labs show a WBC count of 17K, but are otherwise unremarkable. X-ray shows a left-sided retrocardiacopacity concerning for pneumonia.
The patient is clearly symptomatic, but he is asking to go home.

Conclusion

You noted that the patient was otherwise well-appearing, and he did not have any risk factors for drug-resistant organisms or any other significant medical comorbidities. You prescribed amoxicillin 1 g orally, 3 times daily for 5 days. The patient called back to the ED and said he had improved clinically and was essentially asymptomatic by day 3. He was encouraged to complete his 5-day course of antibiotics.