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Title : A 65-year-old female with fever and blood-tinged sputum
Date : December 27, 2009
Contributed by
Doo Ryeon Chung, MD, PhD Samsung Medical Center, Korea
Patient History
Age/Sex A 65-year-old female
Chief complaint fever and blood-tinged sputum
Present illness She has been febrile since 3 days ago. She had a productive cough. Two days prior to admission, she visited a primary physician. A rapid antigen test for influenza A showed positive result and oseltamivir was prescribed with a dosage of 75 mg once daily. Fever has been resolved over two days, however, on the day of admission she expectorated a blood-tinged sputum. She had insomnia and visual hallucination. She had a bilateral chest pain at coughing.
Past medical history ESRD on CAPD Asthma
Physical examination Body temperature 38\'C, respiratory rate 20/min Inspiratory crackles on lung auscultation
Initial laboratory findings CBC: WBC 6,230/uL (PMN 84.2%), Hb 11.5 g/dL, Platelet 78,000/uL CRP 26.7 mg/dL Real time RT-PCR for novel influenz A (H1N1): Positive

Question - ID Case of the Week ( December 27, 2009 )
What organisms do you expect as the cause of pneumonia in this patient?
Correct Answer

Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus (methicillin-resistant) were isolated from initial sputum culture with adequate quality. MRSA showed antibiogram compatible with community-associated MRSA.

She was treated with vancomycin and ceftriaxone and cured without any complications.


Please see attached for more information.

Reviewed and presented by
Doo Ryeon Chung, MD, PhD / Samsung Medical Center, Korea

Attached : 20100101 Case of the Week - Review DR Chung_41184[1].pdf

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