Case – Cough and SOB

CC: cough and SOB

HPI: 38 year old homeless man with 3-4 weeks of a cough with blood tinged sputum, increasing SOB, melaise, subjective fevers and night sweats.  No sick contacts.

PMHx
Spontaneous PTX at age 29 req chest tube
Neg HIV and PPD 5 years prior

Meds:
None

SHx:
Homeless, h/o IVDU, tobacco, 2 days in jail a year prior

FHx:
No pulmonary disease

V: 38.1, 105, 130/80, 20 96% RA
Disheveled, occassional R sided wheeze, 2/6 systolic murmur

Labs:
Na 127, Cr 0.8, Glu 140, WBC 23, Hct 36, Plt 600, LFTs nml, Alb 2.3

CXR

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