A 42-year-old male presents to the emergency department with a 5-day history of productive cough, fever, and acute right-sided pleuritic chest pain. He reports dyspnea on exertion. Vital signs show temperature 38.9°C, heart rate 102 bpm, blood pressure 128/76 mmHg, and respiratory rate 22/min. Physical examination reveals diminished breath sounds and dullness to percussion at the right lung base. Chest radiograph shows a large right-sided pleural effusion with right lower lobe consolidation. Pleural fluid obtained via thoracentesis has the following characteristics: pH 6.8, glucose 28 mg/dL, LDH 850 U/L, protein 4.2 g/dL, and positive gram stain with gram-positive cocci in clusters. Blood cultures are pending. Which of the following is the most likely diagnosis?
- A)Streptococcus pneumoniae pneumonia with parapneumonic effusion progressing to empyemaGABARITO
- B)Staphylococcus aureus pneumonia with purulent pleural effusion
- C)Klebsiella pneumoniae pneumonia with exudative pleural effusion
- D)Mycobacterium tuberculosis with tuberculous pleuritis
- E)Pneumococcal pneumonia with transudative pleural effusion
Explicação
The clinical presentation is classic for S. pneumoniae pneumonia with empyema. The key diagnostic clues are: (1) gram-positive cocci in clusters from pleural fluid gram stain are consistent with S. pneumoniae; (2) pleural fluid pH <7.0 (6.8) indicates an infec... Ver explicação completa e trilha adaptativa →