Case 360


A 22-year-old male comes to the emergency room referring prostration, myalgia, productive cough and 4 episodes of fever up to 39,5 C in the last 7 days. He denies improvement with over-the-counter medications. At physical examination, he's conscious, pallid and with marked sudoresis. Heart auscultation demonstrates presence of S4, and pulmonary auscultation reveals crepitations and reduced pulmonary sounds in the lower left hemithorax. Respiratory rate was 28. The following tests were requested: complete blood count, serology for Dengue virus, chest X-ray and thoracic CT.

Chest radiographs, posteroanterior (PA) and side views.


Computed tomography of the thorax, axial view, from T6 to T10, pulmonary window.


Computed tomography of the thorax, axial view, at the T10 level, mediastinum window.

Given the clinical history, the imaging studies shown and the presence of neutrophilia with left shift in the WBC count, what is the most likely organism involved and the most appropriate next step in management?

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