Lesson Self-Assessment

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 lymph nodes.

What diagnoses would you rule out with this patient?

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