Wade Mckenna, Hughes Kathryn, Miller Russell, Hughes Stephen
Internal Medicine Department, Naval Medical Center San Diego; San Diego, CA.
Pulmonary and Critical Care Department, Naval Medical Center San Diego; San Diego, CA.
Chest. 2025 Feb;167(2):e53-e56. doi: 10.1016/j.chest.2024.07.176.
A 21-year-old man with a history of glucose-6-phosphate dehydrogenase deficiency experienced an acute onset of atraumatic left upper abdominal and flank pain. An initial contrast-enhanced CT scan of the chest, abdomen, and pelvis revealed a consolidation in the left lower lobe, a small pleural effusion, and enlarged mesenteric lymph nodes. The patient was prescribed nonsteroidal antiinflammatory drugs for a presumed viral syndrome and was discharged. He returned the next day with increased pain, new onset of shortness of breath, and a fever of 38.6 °C. A diagnosis of community-acquired pneumonia was made, and doxycycline was prescribed. Twenty-four hours later, he presented again with severe pain, worsening dyspnea, and hypoxemia. A CT angiogram of the chest showed persistent consolidation in the left lower lobe and a now large left pleural effusion. He was admitted to the internal medicine service for the management of pneumonia and presumed para-pneumonic effusion.
