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Complicated Respiratory Case Study at Samsung Seoul Hospital | Detailed Diagnosis and Treatment Journey

In this medical case discussion from November 2015, a 69-year-old male presents with dyspnea, weakness, and complex medical history. Initial treatments, clinical course, and diagnostic findings are analyzed, leading to suspicions of pneumonia, Nocardiosis, or lung cancer. The final report reveals the presence of unidentified Gram-positive bacilli, potentially Nocardia species, highlighting the challenges in managing respiratory infections. Follow the patient's journey and treatment with TMP-SMX over one month at Samsung Seoul Hospital.

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Complicated Respiratory Case Study at Samsung Seoul Hospital | Detailed Diagnosis and Treatment Journey

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  1. 2015년 11월 흉영월례집담회 삼성서울병원차민재

  2. Case 1 M/69 C.C: Dyspnea, General weakness P.Hx: HTN/DM/Hepatitis/TB (+/+/-/-) COPD BP:113/71 (mmHg), PR:110 (/min), RR:22 (/min), BT: 36.7 (˚C)

  3. 2015-03-20 Tx: 3rd cepha + macrolide  tazolactam + ciprofloxacin

  4. 2015-04-02

  5. 2015-04-02

  6. 2015-04-02

  7. Clinical course • Pleural effusion analysis • Polymorphonuclearleukocytes dominant exudate • Glucose 150 ADA 20 • Culture (-), Fungus culture (-), AFB (-) • Leukocytosis, elevated ESR (47 mm/hr) and CRP (9.6 mg/dl) • Prolonged general weakness and fatigue

  8. Clinical course • Volume expanding pneumonia? -- Klebsiella? Pseudomonas? • Nocardiosis? • Lung cancer (adenocarcinoma)?

  9. 2015-04-06

  10. bronchoscopy LLL RLL

  11. EBUS-Guided Bx.

  12. -- Suppurative and necrotizing inflammation -- No evidence of malignancy (4R, 7 LN: no evidence of malignancy) -- AFB : No positive microorganism identified

  13. GMS stain: reveals microorganism, probably bacilli

  14. Isolate : #01 Organism : Unidentified Gram positive bacilli (branched) Highly suspicious for Nocardia species

  15. Final report

  16. 2015-04-13 AP 2015-05-11 PA TMP-SMX (bactrim), 1 mon

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