Goswami Kanishka, Singh Gurjot, Sharma Tanisha, Farooq Amna, Puri Piyush
General Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND.
Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND.
Cureus. 2024 Jun 6;16(6):e61853. doi: 10.7759/cureus.61853. eCollection 2024 Jun.
A 41-year-old woman presented with a 3.5-month history of fever, weakness, productive cough, and burning micturition along with generalized weakness and significant weight loss. Chest X-ray revealed bilateral infiltrates and bilateral pleural effusion, and the workup suggested community-acquired pneumonia (CAP). However, the course was complicated by persistent fevers, elevated inflammatory markers, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and pelvic fluid collection. Extensive investigations, including bronchoscopy and lung biopsy, failed to identify a specific pathogen. Pulmonary vasculitis and lymphoma were ruled out. Antibiotic and corticosteroid therapy resulted in clinical improvement. While the cause remains unknown, brucellosis and aspergillosis were considered but ruled out with advanced testing. The underlying etiology remains elusive, highlighting the diagnostic challenges in CAP with atypical presentations.
一名41岁女性，有3.5个月的发热、乏力、咳痰、尿痛病史，伴有全身无力和明显体重减轻。胸部X线显示双侧浸润影及双侧胸腔积液，检查提示社区获得性肺炎（CAP）。然而，病程中出现持续发热、炎症指标升高、N末端B型利钠肽原（NT-proBNP）升高及盆腔积液等并发症。包括支气管镜检查和肺活检在内的广泛检查未能发现特定病原体。排除了肺血管炎和淋巴瘤。抗生素和糖皮质激素治疗后临床症状改善。虽然病因仍不明，但考虑过布鲁氏菌病和曲霉病，经进一步检查已排除。潜在病因仍难以捉摸，凸显了非典型表现的CAP诊断挑战。
