A 62-year-old man is brought to the emergency department with fatigue, dry cough, and shortness of breath for 3 days. He reports a mild fever and has also had 3 episodes of watery diarrhea earlier that morning. Last week, he attended a business meeting at a hotel and notes some of his coworkers have also become sick. He has a history of hypertension and hyperlipidemia. He takes atorvastatin, hydrochlorothiazide, and lisinopril. He appears in mild distress. His temperature is 38.9°C (102.1°F), pulse is 56/min, respirations are 16/min, and blood pressure is 150/85 mm Hg. Diffuse crackles are heard in the thorax. Examination shows a soft and nontender abdomen. Chest x-ray shows bilateral lower lobe interstitial infiltrates. Which of the following additional findings is most likely to be present in this patient?

Question

A 62-year-old man is brought to the emergency department with fatigue, dry cough, and shortness of breath for 3 days. He reports a mild fever and has also had 3 episodes of watery diarrhea earlier that morning. Last week, he attended a business meeting at a hotel and notes some of his coworkers have also become sick. He has a history of hypertension and hyperlipidemia. He takes atorvastatin, hydrochlorothiazide, and lisinopril. He appears in mild distress. His temperature is 38.9°C (102.1°F), pulse is 56/min, respirations are 16/min, and blood pressure is 150/85 mm Hg. Diffuse crackles are heard in the thorax. Examination shows a soft and nontender abdomen. Chest x-ray shows bilateral lower lobe interstitial infiltrates.  Which of the following additional findings is most likely to be present in this patient?

Quizplus · Accepted Answer

Eductional Objective: Legionella pneumophila is a facultative intracellular gram-negative bacillus that can cause a systemic infection.  Symptoms frequently include high fever, cough, confusion, and diarrhea.  The most common laboratory abnormality seen with Legionella pneumonia is hyponatremia, and sputum Gram stain often shows many neutrophils but few or no organisms.

A 62-Year-Old Man Is Brought to the Emergency Department with Fatigue