1) A 36-year-old female from Chicago, Illinois
awoke yesterday with an onset of malaise, body aches, chills,
headache and GI symptoms, including nausea, vomiting, and diarrhea.
She awoke this morning with worsening symptoms, including severe
abdominal pain, productive cough and shortness of breath. The
patient works as a housekeeper at a large hotel. She hasn't traveled
recently. She has one healthy cat at home and hasn't been exposed
to any ill animals. Her exam findings show she has a cough producing
thick, bloody sputum, bilateral rales, little-to-no air movement
in the left lower lung field, and dullness on percussion over
the lower half of her left lung. Chest radiograph showed bilateral
infiltrates with consolidation in the left lung field. CSF obtained
via the LP was cloudy in appearance. Her temperature was 103.5°F,
and her pulse was rapid and thready. Liver not enlarged, no enlarged
What diagnoses would you rule out with this patient?