A 67-year-old man with diabetes and hypertension presented with worsening fever, malaise, dyspnea, and abdominal pain over two days. On examination, he had a fever, rapid heart rate, diffuse lung rhonchi, and normal abdomen. A chest X-ray showed patchy infiltrates and peri-hilar prominence. Given his atypical presentation and chest X-ray findings, he was started on a macrolide or respiratory fluoroquinolone antibiotic for suspected atypical pneumonia.

2.  67 yr old male with pmhx
notable for dm/htn
presents with 2 days
subjective
f/c, malaise, increasing
dyspnea with exertion and
abdominal pain. He
endorses an occasional dry
cough and decrease
appetite without chest
pain/diaphoresis, his
course has been progressive
with no alleviating factors.
He denies past similar
episodes and was in his
usual state of health until 2
days ago.
 T 102.8 P 125 BP 150/90
O2 92% RR 20
 Gen: ill-appearing
 CV:
Tachycardic, RRythm;
ext. warm with good
cap refill/ pulses
appropriate.
 Pulm: diffuse rhonchi
with moderate air
mvmt.
 Abd: s/nt/nd – normal
bowel sounds, heme

4. 1. Note patchy infiltrates with peri-hilar prominence (adenopathy)
2. No evidence of isolated consolidation – diffuse process

5.  Oxygen
 IV Fluids
 Antibiotics
 Unresponsive to B-lactam abx
 Use macrolide or resp. fluoroquinolone
 Admit
 Location based on acuity/clinical picture/comorbidities

6.  Presentation
 “Atypical” pneumonia can present with generalized complaints
without specific respiratory symptoms usually associated with
pneumonia (cough/congestion/chest pain).
 CXR
 Based on atypical pattern on chest x-ray, abx selection should
be directed at an atypical infection.
 ABX
 Organisms responsible for atypical pneumonia include
Legionella, Chlamydophila, Mycoplasma, and viruses
(including influenza)

7.  Populations
 Atypical pneumonia is most commonly found in older
children, young adults, and the elderly – in addition to those
populations at higher risk for a respiratory infection
(underlying lung disease, immunocompromised).
 Organism specific
 Remember summer prevalence and GI complaints with
Legionella presentations
(nausea/vomiting, diarrhea, abdominal pain)
 Mycoplasma infections are sometimes associated with bullous
myringitis in addition to other extra-pulmonary findings
(rash, arthritis/arthralgias, ).