An unusual masquerade of community acquired pneumonia: Left-side unilateral pulmonary edema
A 76-year-old man, a known case of dilated cardiomyopathy, presented to the Emergency Department with severe breathlessness and cough productive of blood stained sputum of 2 days duration. His compliance with diet and medication was poor.\nAt admission, he was orthopnic, had an RR of 40 bpm, BP of 140/100 mmHg, HR of 110/min, and body temperature of 37.2°C. His neck veins were full, and there was pedal edema. Respiratory system examination revealed impaired percussion note and fine crackles in the entire left hemithorax. Cardiac auscultation revealed S3 gallop and a high-pitched, holosystolic murmur at apex radiating to the left axilla.\nLaboratory investigations revealed a TLC of 14000/μL with 75% neutrophils. Chest radiograph showed left-sided airspace disease with cardiomegaly [] and electrocardiogram showed LBBB. His creatinine 1.4 mg/dL, sodium 140 mEq/L, potassium 4.0 mEq/L, B-natriuretic peptide 1200 pg/mL, creatine kinase isoenzyme MB 6.1 ng/mL, and troponin I 0.14 ng/mL.\nDifferential diagnosis of pneumonia versus UPE was kept. He was started on oxygen, diuretics, low molecular weight heparin, GTN infusion, anti-platelets, statins, intravenous antibiotics (cefepime and azithromycin), and non-invasive mechanical ventilation. Echocardiography done revealed a reduced global left-ventricular ejection fraction (LVEF 35%), and a large eccentric mitral regurgitation jet reaching the left pulmonary veins. His serial CRP and PCT were low. His cultures (sputum and blood) did not grow any organism, and therefore antibiotic were discontinued on day 4. With decongestive therapy, there was significant clinico-radiological improvement. Repeat chest radiography done after 48 h of admission showed significant resolution of the unilateral opacities []. The patient was discharged uneventfully on day 5 of hospitalization, and presently he is on a regular follow-up with the Cardiology Department.