google-site-verification=DIvXa0sVJLwwOdbOqjFUQOLOXK0uc7WKBvJSHMl_8vc

Case Report: 51 year old man with worsening pneumonia while hospitalized

History

51 yo with increasing shortness of breath, cough and weakness over a period of a few weeks.

  1. No previous significant past medical history

  2. Low grade fever

  3. Works as a custodian and was subjected to a lot of second-hand smoke

His initial CXR:

Initial CXR

Hospital Course

  1. Initially placed on Rocephin, Levaquin and Doxycycline

  2. Started on Solumedrol IV for several days.

  3. Initial culture of sputum: Normal flora; Influenza culture: Negative

  4. Had a bronchoscopy 5 days after admission for worsening respiratory distress: negative stains for Pneumocystis (PJP). Gram stain showed “few Gram positive cocci. Culture grew “yeast and normal respiratory flora”

Near completion of therapy inpatient

CXR after persistent worsening of his shortness of breath

On account of CXR findings, a CT scan was ordered:



CT pulmonary and parenchymal views (different levels)

Question 1: What process is likely being depicted in this CT scan?

  1. The patient underwent a Video-Assisted Thoracoscopic surgery (VATS) with decortication on account of the findings)

  2. Cardiothoracic (CT) surgery found an area of necrotic tissue in the setting of the Right lower lobe process and a thick pleural peel.

Pathology contacted the physician after their review:


H and E stain Pulmonary Parenchymal Tissue


Specialized stains: Lung tissue High Power

Question 2: What is the name of the specialized stain shown above? Why is it used?

Question 3: What is shown using this specialized stain?

Question 4: What do you suspect was the diagnosis and likely risk factors? Hint: Risk factors are from history, hospital course and discovered (at least 3).

Click for the answer to this week’s ID Case Report Challenge.

Share this:

  1. Click to share on Twitter (Opens in new window)

  2. Click to share on Facebook (Opens in new window)

  3. Click to print (Opens in new window)

  4. Click to share on LinkedIn (Opens in new window)

  5. Click to email this to a friend (Opens in new window)

  6. Click to share on Reddit (Opens in new window)

  7. Click to share on Tumblr (Opens in new window)

  8. Click to share on Pinterest (Opens in new window)

  9. Click to share on WhatsApp (Opens in new window)