A 35-year-old male presented with a temperature of 38.3°C, cough producing purulent secretions, and flecks of blood in his sputum. A physical exam found inspiratory rales in his right lung base and chest x-ray showed bilateral lower lobe infiltrates more pronounced on the right. He was diagnosed with community-acquired pneumonia based on his symptoms, physical findings, and test results.

1. A Patient with Mild
Community-Acquired
Pneumonia

2. Patient: XXX
Age: 35 years
Gender: Male
Chief Complains:
• Temperature: 38.3°C
• Spasms of coughing that produce purulent secretions
• On one occasion, he noted a few flecks of bright-red blood in his sputum

3. Past history
• No history of familial illness, hospitalizations,
or trauma
• No drug allergies or intolerance
• The only medication he takes is acetaminophen
occasionally, for headaches
• He drinks beer or wine in moderation
• Smokes 1 pack/day and has done so since the age of
15 years

4. Physical Examination
• Body temperature: 38.9°C (100°F)
• Pulse: 110 beats/min and regular
• Respiratory rate: 18 breaths/min
• Oxygen saturation: 93% while breathing room air
• Presence of mild erythema of the mucosa of the
nose and posterior oropharynx
• Inspiratory “rales” are heard at the right lung
base

5. Laboratory and radiographic findings
• Hemoglobin: 12.5 g/dL
• Hematocrit: 36%
• WBC: 13,500 cells/µL
• Polymorphonuclear cells: 82%
• Band forms: 11% band forms
• Lymphocytes: 7% lymphocytes
• Platelet count: 180,000 cells/µL
• Chest radiography: Bilateral lower
lobe infiltrates that are more
pronounced on the right side.
There are no pleural effusions.

6. What is the likely diagnosis?
• A. Asthma
• B. COPD
• C. Community acquire pneumonia

7. C. Community acquired pneumonia
Based on physical and laboratory criteria the patient was diagnosed with community acquired pneumonia.
 Community-acquired pneumonia is a leading cause of hospitalization, mortality, and incurs significant health
care costs.
 CAP is a common working diagnosis and is on the differential diagnosis of patients presenting
with respiratory tract infections, patients with cough and abnormal chest imaging, and patients with sepsis.
 For outpatients, monotherapy with a macrolide (erythromycin, azithromycin, or clarithromycin) or
doxycycline is recommended.
 In the presence of comorbid illness (chronic heart disease excluding hypertension; chronic lung disease -
COPD and asthma; chronic liver disease; chronic alcohol use disorder; diabetes mellitus; smoking;
splenectomy; HIV or other immunosuppression) a respiratory fluoroquinolone (high-dose levofloxacin,
moxifloxacin, gemifloxacin) or a combination of oral beta-lactam (high dose amoxicillin or amoxicillin-
clavulanate, cefuroxime, cefpodoxime) and macrolide is recommended.