Morning Report

Case 1

Dr Amelia Muhs

CC: 1wk flank pain, dark urine, dyspnea

HPI: 24F 1wk b/l flank pain, dark urine, subjective fever x1wk, +intermittent dyspnea, no productive cough.

ROS: 30lb unintentional wt loss over 6mo, night sweats 5-6 nights/wk, no measured fevers, intermittent hip and knee pain after work, no [rashes, throat pain, HA, n/v]

PMH: COVID 8mo ago, tx for bartonella w azithro 1mo ago

Meds: none

FH: maternal grandmother (Graves)

Social: no tobacco, 2-3 EtOH/wk, vapes mj 1-2x/wk, work: vet tech


wnl other than 101.8F, 102 HR, wt 105lb, 65”

Labs: WBC 14.3 (90% PMN), ALK 205, Cr 0.8, UA wnl, Ferritin 803, D bili 1.8, CRP 303, ESR 79

Huge infx w/u -ve (tularemia didn't get sent, on accident), rheum w/u -ve other than ANA 1:160.

Got better rapidly w LVQ (did not get better w 1d CAP covg, 1-2d vanc-cefe).

Presumed dx: Legionella

Legionella and other atypical pna


w/u: - BAL/tissue/pleural fluid cx, needs buffered charcoal yeast extract agar, 4-5d process, sens 20-80, spec 100% - U Ag test: only detects serogroup 1, sens 70-80%,

Atypical pna: 22% CAP in US. legionella pneumophila (U Ag), chlamydia pneumoniae (PCR - remains + for months to a year), mycoplasma pneumoniae (PCR)

Other learning points: - renal failure in young female needs formal pelvic eval, cervical cancer can met to LN and cause obstruction