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
Exam:
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
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