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Internal Medicine

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42-year-old man with progressive cough, fever, and shortness of breath for three weeks. He recently placed mulch in his backyard.

Patient History:

  • Medical Conditions: Hyperlipidemia and hypertension.

  • Medications: Atorvastatin 20 mg daily, lisinopril 10 mg daily.

  • Lifestyle: Non-smoker.

  • Recent Activity: Recently placed mulch in his yard.

Physical Examination:

  • Temperature: 38.5°C (101.3°F)

  • Heart Rate: 117 beats per minute

  • Respirations: 32 per minute

  • Oxygen Saturation: 88% on room air

  • Lung Examination: Crackles in both lung bases, no wheezing or prolonged expiration.

Laboratory Studies:

  • Hematocrit: 42.7% (normal range 42%–50%)

  • Leukocyte Count: 13,500/µL (elevated; normal range 4000–11,000/µL)

  • Neutrophils: 82% (elevated; normal range 50%–70%)

  • Lymphocytes: 15% (decreased; normal range 30%–45%)

  • Monocytes: 2% (normal range 0%–6%)

  • Eosinophils: 1% (normal range 0%–3%)

  • Platelet Count: 350,000/µL (normal range 150,000–450,000/µL)

Imaging and Other Findings:

  • Chest Radiography: Bilateral diffuse mixed ground-glass and reticular opacities.

  • BAL (Bronchoalveolar Lavage) Fluid Analysis: 60% lymphocytes, 26% eosinophils.

  • Cultures: No microorganisms or malignant cells found.

  • Viral Panel: Negative.

Your diagnosis?

Harsh Sura
Jul 09


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