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A 20-year-old male college student presented to the emergencydepartment of the Wilford Hall Medical Center. He complained of a 1-hourhistory of cough and generalized malaise. He was passing urine at home, and feltlightheaded when he sat upright. On admission, he was afebrile with a blood pressure of 110/90 mm Hg and pulse of 100 beatsper minute. He was tachypneic with normal mental status. He had respiratoryrates between 32 and 36, and was bedbound. Auscultation of his chest revealedno abnormal findings. A stool occult blood test returned positive. The remainingvital signs were unremarkable. He was given pain medication and intravenousfluids. He was sent home on a 3-day course of ceftriaxone for urinarytract infection. He presented 5 days later with an exacerbation of his respiratory symptoms. He was given intramuscular methylprednisolone, and his medications werecancelled. He was readmitted 3 days later with the same complaints. Hecontinued to lose weight, and was febrile with continued respiratory symptomsand a positive stool occult blood test. A chest x-ray was ordered and showed alabyrinth pattern of interstitial opacities.
A 35-year-old female college student was seen in the urgent careclinic of the Wilford Hall Medical Center, complaining of chest pain and shortness of breath. She had become ill 3 days earlier after returning from a vacation spent withher family in Canada. She noted a 3-day history of productive cough, night sweats,and malaise. The only other significant event during the prior 2 weeks was a lymphadenopathy,which was diagnosed as a parotid mass while she was visiting her physician in her homecountry. She denied any fever, lightheadedness, sick contacts, or dizziness. She was afebrile, normotensive, with a blood pressure of 110/70 mm Hg and a pulse of 72beats per minute. She was afebrile with a temperature of 36.4 C (97.3 F). She had no respiratory complaints, and apnoea, wheezing, and accessory muscle use were not noted upon auscultation of her chest. d2c66b5586