2021-11-08-mr-muhs.md (1389B)
1 # Morning Report 2 3 4 # Case 1 5 6 Dr Amelia Muhs 7 8 CC: 1wk flank pain, dark urine, dyspnea 9 10 HPI: 24F 1wk b/l flank pain, dark urine, subjective fever x1wk, 11 +intermittent dyspnea, no productive cough. 12 13 ROS: 30lb unintentional wt loss over 6mo, 14 night sweats 5-6 nights/wk, 15 no measured fevers, 16 intermittent hip and knee pain after work, 17 no [rashes, throat pain, HA, n/v] 18 19 PMH: COVID 8mo ago, tx for bartonella w azithro 1mo ago 20 21 Meds: none 22 23 FH: maternal grandmother (Graves) 24 25 Social: no tobacco, 2-3 EtOH/wk, vapes mj 1-2x/wk, work: vet tech 26 27 Exam: 28 29 wnl other than 101.8F, 102 HR, wt 105lb, 65" 30 31 Labs: 32 WBC 14.3 (90% PMN), ALK 205, Cr 0.8, UA wnl, Ferritin 803, D bili 1.8, CRP 303, ESR 79 33 34 Huge infx w/u -ve (tularemia didn't get sent, on accident), rheum w/u -ve other than ANA 1:160. 35 36 Got better rapidly w LVQ (did not get better w 1d CAP covg, 1-2d vanc-cefe). 37 38 Presumed dx: Legionella 39 40 ## Legionella and other atypical pna 41 42 Legionella 43 44 w/u: 45 - BAL/tissue/pleural fluid cx, needs buffered charcoal yeast extract agar, 4-5d process, sens 20-80, spec 100% 46 - U Ag test: only detects serogroup 1, sens 70-80%, 47 48 Atypical pna: 22% CAP in US. legionella pneumophila (U Ag), chlamydia pneumoniae (PCR - remains + for months to a year), mycoplasma pneumoniae (PCR) 49 50 51 Other learning points: 52 - renal failure in young female needs formal pelvic eval, cervical cancer can met to LN and cause obstruction 53