History of Present Illness
A 54-year-old woman with history of asthma and appendiceal adenocarcinoma status post-appendectomy presented to the emergency department with 3 weeks of shortness of breath, sinus congestion, cough productive of green sputum, lower extremity edema, and general malaise. She had been treated with 2 weeks of oral amoxicillin–clavulanate without improvement. She was found to be hypoxemic with oxygen saturation of 89% on room air and multiple opacities on chest x-ray. She had an elevated white blood cell count of 33,680/μL (95% neutrophils). Computed tomography (CT) scan of the chest revealed diffuse alveolar hemorrhages, which were confirmed on bronchoscopy. She was admitted to the hospital and subsequently developed oliguric acute renal failure. A renal biopsy was performed, revealing crescentic glomerulonephritis. She was given 4 days of intravenous (IV) methylprednisolone 1 g/day and one dose of 880 mg IV cyclophosphamide. Routine blood culture grew out yeast, and ophthalmology was consulted to evaluate for possible fungal endophthalmitis.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/25 | 20/25 |
| Intraocular pressure | 17 | 18 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber | Deep and quiet | Deep and quiet |
| Iris | Unremarkable | Unremarkable |
| Lens | Clear | Clear |
| Anterior vitreous | Clear | Clear |
| Dilated fundus examination (DFE) | See Fig. 61.1A | See Fig. 61.1B |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
