Cough, fever, dyspnoea, h...

A 60-year-old man presented to the emergency room (ER) with a 2-day history of cough, fever, dyspnoea, and left hemiparesis. In addition, he had diabetes mellitus and was a current smoker. On arrival at the ER, his vital signs were as follows: blood pressure, 110/80 mmHg; respiratory rate, 22 breaths/minute; heart rate, 90 beats/minute; and oxygen saturation, 88%. 

Examination

On physical examination, lung sound was clear. However, neurologic examination showed grade 2/5 left hemiparesis, dysarthria, and left facial palsy. Initial chest radiography showed no pneumonic infiltrates in both the lungs. Laboratory examination performed at the ER showed the following results: white blood cell count, 22.4 × 103/mm3; hemoglobin, 10.7 g/dL; platelet, 291 × 103/mm3; blood urea nitrogen, 30.7 mg/dL; creatinine, 1.57 mg/dL; glucose, 305 mg/dL; C-reactive protein, 35.32 mg/dL; procalcitonin, 0.580. Liver function test and electrolyte level measurement showed normal results. Influenza A virus was detected using the rapid influenza diagnostic test.