Case report III
A fever
Monika Bratova

Man, 55-year old, non-smoker, hypertension and GERD in patient´s history, working as a construction
manager, living with his wife
Hyperstenic habitus, without neurological problems, a regular heart beat, without a heart murmur,
breathing - silent breathing above the base and crackles in the middle part of the left lung,
abdomen without any resistance, tappotment negative, down extremities without edema
Symptoms:
Suffering from fevers around 38°C more then 4 days. He has a chest pain on the left side of thorax,
dyspnea and purulent sputum. Without dysuria. He took penicilin antibiotics without any clinical
effect.

Which basic examination should be done?
Physiologic ECG
Saturation O2 98%
Blood account
Biochemistry
Leucocytes 13,7
Urea 5,0
Erytrocytes 4,0
Kreatinine 81
Hemoglobin 125
Kalium 3,8
Trombocytes 300
CRP 140

The infiltration of the left lung, maily in the middle and down lobe, left-sided fluidothorax,  no
enlargement
of the heart

What is a possible cause of the X-ray finding?
A pneumonia with a pleural effusion:
PLUS – a fever, high inflammatory markers, the X-ray finding, the typical auscultation finding
CONTRA – without effect of antibiotics
A heart failure:
PLUS – a presence of a fluidothorax, a dyspnoe
CONTRA –  without a heart failure in the patient´s history, an unilateral X-ray finding, without an
enlargemnet of the heart or edema of down extremities, do not explain a fever
Lung cancer:
PLUS – the X-ray finding, persisting despite antibiotics
CONTRA – non-smoker, acute symptoms, without a weigh lost
A pyelonephritis:
PLUS – a localization of the pain, a fever, high inflammatory markers
CONTRA – do not explain the X-ray finding, no dysuria, a negative tapottment

Which further examination should be done?
An abdomen ultrasonography without pathology
A sputum pozitive from Haemophillus influenzae in the concentration 10-7
CT scan: The infiltration of the left lung typical for pneumonia, a massive left-sided
fluidothorax, without lymfadenopathy
Biochemistry urine examination without evidence of the infection

Conclusion
•Diagnosis of pneumonia with a pleural effusion •A chest drainage with an evacuation of the empyema
was managed, flushed by Betadine •The double combination of antibiotics were administered until 3
weeks •We observed a slow regression of the lung infiltration
•