-year-old white male patient was transferred to our hospital for
worsening pneumonia. He had been admitted to an outlying hospital with
a 1-week history of increasing dyspnea, cough productive of green
sputum, and right-sided chest pain associated with night sweats. His
medical history was significant for an 80 pack-year smoking history,
diabetes mellitus, coronary artery disease, alcohol abuse, and gout.
The patient had been self-employed as a logger and worked in the New
England region, except for a trip to Tennessee 4 months prior to
presentation. A diagnosis of community-acquired pneumonia was made at
the outlying hospital, and the patient was begun on a combination of
cefazolin and clarithromycin. After 4 days of therapy, the patient had
a worsening of symptoms and progression of the radiologic
abnormalities, prompting his transfer to our hospital.