Contributed by Debra L. Callahan, MD
Published on line in April 1999
The patient was a 35 year old African American woman with a history of diabetes, hypertension, and obesity. (Twenty years earlier, she had been treated with one year of prophylactic antibiotics after a positive PPD test.) She presented with shortness of breath and a chest x-ray demonstrated bilateral pulmonary infiltrates. She was treated with antibiotics for a suspected viral pneumonia and failed to improve. She was admitted and treated with intravenous antibiotics, clinically improved, and was discharged. A follow-up chest x-ray two weeks later demonstrated no clearing of the pulmonary infiltrates. She had a non-productive cough and dyspnea on exertion. The patient was re-admitted with increased pulmonary infiltrates in a diffuse and alveolar pattern. On physical examination, she had moderate jugular venous distension, bilateral expiratory wheezes, a temperature of 99.4F, tachycardia at 136 beats per minute, and tachypnea at 24 breaths per minute. She was treated with bronchodilators and oxygen supplementation. The patient developed respiratory distress and was intubated. She became bradycardic and in spite of vigorous attempts at resuscitation, she expired.