Cough with dyspnoea

A 35-year-old woman presented to the emergency department (ED) with a two-week history of a cough and dyspnoea. She was provisionally diagnosed with pneumonia, following a chest X-ray and clinical work up at an outlying hospital facility. The patient was a poor historian, but she acknowledged a cough, shortness of breath, and sore throat, and she denied any recent travel, exposure to any chemicals, or any pets. Her past medical history was significant for schizoaffective disorder, hypothyroidism, hypertension, and obesity. The patient had no history of substance abuse.

Because of her worsening clinical condition, she was admitted to the intensive care unit (ICU). Her blood pressure was 142/75 mmHg, heart rate 112 beats/min, respiratory rate of 24 breaths/min, temperature 98.6°F and oxygen saturation of 94% on oxygen supplementation with a nasal cannula that delivered oxygen at a rate of 6 L/min. She was sitting up in bed, oriented only to the person, and was in moderate respiratory distress. Cardiac examination was unremarkable except for her tachycardia. Lung examination showed reduced air entry and crackles in both lung bases.