Mentions: A week after discharge, he was readmitted to our hospital with lethargy, fever, hypotension, and hypoxia. He denied sick contacts or occupational exposures. On arrival, he was afebrile and normotensive. His lung examination revealed bibasilar decreased breath sounds and inspiratory crackles more prominent on the left. There was bilateral lower extremity edema and chronic skin discoloration. His laboratory examination was notable for leukocytosis of 13.8 K/CU MM, troponin I elevation to 2.65 ng/mL (peak), BNP 563 pg/mL, arterial blood gas pH 7.46 pCO2 40 mmHg paO2 61 mmHg O2 Sat 94% on continuous positive airway pressure of 8 cmH2O and FiO2 of 0.40. The electrocardiogram showed non-ST segment elevation myocardial infarction and the initial impression was demand ischemia secondary to hypoxemia. A chest x-ray showed bilateral upper and lower lobe airspace opacities. A computer tomography (CT) scan of the chest showed bilateral diffuse ground glass opacities in the upper lobes, lingula and left lower lobe consolidations, and a small right pleural effusion (Figure 1). He was treated with supplemental oxygen and broad-spectrum antibiotics for healthcare-associated pneumonia.
Patient: male, 51"/>