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MEDICAL CASE No. 2

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MEDICAL CASE No. 2




Student, 5-day history of cough, low-grade fever, sore throat, and coryza [WINNER]
Posted on Tuesday, April 28, 2009 in Infectious Disease, Pulmonology

A 26-year-old female student presents with a 5-day history of cough, low-grade fever (temperature 37.6 C), sore throat, and coryza.
On exam, there is mild conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is seen. Chest exam shows few basilar rales.

Laboratory findings are as follows:
Hct: 38
WBC: 12,000/μL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 83 nL
Reticulocytes: 3% of red cells
CXR: bilateral patchy lower lobe infiltrates


The sputum Gram stain is likely to show

a. Gram-positive diplococci
b. Tiny gram-negative coccobacilli
c. White blood cells without organisms
d. Acid-fast bacilli


This patient is likely to have

a. High titers of adenovirus
b. High titers of IgM cold agglutinins
c. A positive silver methenamine stain
d. A positive blood culture for Streptococcus pneumoniae


Treatment of choice is

a. Erythromycin
b. Supportive therapy
c. Trimethoprim-sulfamethoxazole
d. Cefuroxime

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