- A 52-year-old female presented with a 1-month history of cough and fevers after being treated for breast cancer. She was admitted to the hospital with worsening shortness of breath. - On admission, she had abnormal lab results including elevated white blood cell count. A chest CT showed abnormalities. Antibiotics were started but she continued to spike fevers. - Sputum cultures grew gram-positive cocci. Bronchoscopy with biopsy showed inflammatory infiltrate but did not reveal a definitive diagnosis. Further diagnostic testing was done on hospital day 5.

1. Clinical Pathological Case Conference February 13, 2008

11. Laboratory Assessment: TEST REFERENCE RANGE ON ADMISSION HEMATOLOGY Hemoglobin 13.5 – 17.5 g/dl 13.3 Hematocrit 41.0 – 53.0 % 41.9 White-cell count 4,500 – 11,000 per mm 3 14.7 Differential Count Neutrophils 40 – 70 % 84 Lymphocytes 22 – 44 % 7 Monocytes 4 – 11 % 8.1 Eosinophils 0 – 8 % 1 Platelet Count 150,000 – 300,000 per mm 3 643 Partial-thromboplastin time 22.1 – 35.1 sec 33.3 INR 0.8 – 1.2 1.4

12. Laboratory Assessment: TEST REFERENCE RANGE ON ADMISSION CHEMISTRY Sodium 135 – 145 mmol/liter 138 Potassium 3.4 – 4.8 mmol/liter 4.0 Chloride 100 – 108 mmol/liter 98 Carbon dioxide 23.0 – 31.9 mmol/liter 26 Urea nitrogen 8 – 25 mg/dl 11 Creatinine 0.6 – 1.5 mg/dl 0.8 Calcium 8.5 – 10.5 mg/dl 9.2 Erythrocyte Sedimentation Rate Female: 1-25 mm/hr Male: 0-17 mm/hr 58

13. Laboratory Assessment: 3.3 3.5-5 g/dL Albumin 7.0 6 – 8.3 g/dL Total Protein 0.0 8 – 25 µmol/L Direct Bilirubin 0.7 2 – 14 µmol/L Total Bilirubin 357 30 -120 IU/L Alkaline phosphatase 48 10 – 40 IU/L Aspartate transaminase 68 5 – 40 IU/L Alanine transaminase Liver Function Test ON ADMISSION REFERENCE RANGE TEST