Case presentation A 28-year-old male presented to the emergency department with the chief complaints of six days of fever with shaking chills. Over the past two days, he has also developed a productive cough with greenish sputum, which is occasionally blood-streaked. He reports no dyspnea but sometimes experiences chest pain on deep inspiration. Past medical history: Not significant Social history: He smokes cigarettes and marijuana regularly and drinks several beers daily but denies intravenous drug use.
Physical examination : Temperature - 102.5°F Heart rate - 109 bpm Blood pressure - 128/76 mm Hg Respiratory rate - 23 breaths per minute He is alert and talkative. He has no oral lesions, and funduscopic examination reveals no abnormalities. His jugular veins show prominent V waves, and his heart rhythm is tachycardic but regular with a harsh holo-systolic murmur at the left lower…
