Patient Introduction
Juan Garcia is a 38-year-old Hispanic male admitted to the hospital with a 2-day history of worsening cough, fever and difficulty breathing.
History of Present Illness
Juan reports having a cough and congestion for about a week but over the past 2 days the cough has worsened and he developed a high fever of 102°F. He also notes increased shortness of breath with any exertion. He has a history of smoking a pack of cigarettes daily for 15 years.
Physical Exam
Vital signs are temperature 101.8°F, heart rate 110/min, respiratory rate 24/min, blood pressure 130/80 mmHg, and oxygen saturation of 90% on room air. Lung exam reveals coarse breath sounds bilaterally with crackles heard in the lower lobes.
Diagnostic Testing
Chest x-ray shows bilateral infiltrates consistent with pneumonia. Complete blood count shows leukocytosis of 12,000/uL. COVID-19 PCR test is negative. Blood cultures are pending. EKG shows sinus tachycardia but is otherwise normal.
Treatment
Juan was started on intravenous ceftriaxone and azithromycin in the emergency department based on suspected community-acquired pneumonia. He is receiving supplemental oxygen via nasal cannula at 3L/min to maintain oxygen saturation above 92%.
Hospital Course
It is important to closely monitor Juan’s clinical status, vital signs and oxygen requirements over the next 24-48 hours. Serial chest x-rays will help assess treatment response. Given his history of smoking, he will require smoking cessation counseling. If no clinical improvement is seen in 48 hours, further workup with sputum cultures or CT chest may be indicated to identify any complications. (Dharmarajan et al., 2017) Prompt treatment of any underlying conditions like COPD will help reduce risk of recurrent pneumonia.

Juan Garcia is a 38-year-old Hispanic male admitted
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