Make the Diagnosis: Several Possible Culprits…

Allergies & Asthma

Presentation

A 52-year-old man presented to the ED appearing ill and with complaints of cough, dyspnea, pleuritic chest pain, and fever. On physical examination, the patient had a temperature of 104°F (40°C). No recent travel history. The patient worked as a commercial plumber and recently completed a plumbing job for a large facility that had been closed for months. His symptoms began approximately 1 week after completing that project. Radiographic and CT features showed ground glass opacities and focal/confluent consolidation. Labs showed hyponatremia and rhabdomyolysis. The patient had a 35-plus-year history of cigarette smoking and had chronic obstructive pulmonary disease.

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