Case history/examination
A 67-year-old male patient was admitted to our hospital with complaints
of continuous and gradually worsening shortness of breath, fever,
productive cough, headache, loss of apetite, and weight loss since 1.5
months ago which got worse 15 days prior to admission. Meanwhile, he had
visited the outpatient clinic several times and had no improvement. He
was a chef from a city from north of Iran with 5 children. Medical
history revealed inguinal surgery for hernia,10 years ago and prostate
surgery, 1 year ago. His social history, familial history and drug
history were unremarkable, except seretide and salbutamol that were
started in 15 recent days. The physical examination revealed a somnolent
patient with 13/15 score on the Glasgow coma scale, who was febrile
(T:38.8 °C) and had BP:90/60, RR:32 breaths/ min, PR:98 breaths/ min. He
was in respiratory distress and required oxygen therapy to maintain
saturation, so that his O2 saturation was 76% while he was breathing
ambient air and with mask 92%. Severe thrush was detected in the
oropharynx. In addition, bilateral crackles were detected on pulmonary
auscultation.