Case of an Ex-smoker with Cough and Fever

Malaysian origin ex-smoker female had a history of asthma with no hospitalization and minimal use of Salbutamol inhaler. At the emergency department (ED), she came with a history of a 1-day fever and 3-week cough producing white sputum and dyspnea on exertion. There is no recent history of traveling or contact with a sick person, no myalgia/arthralgia, and no family history of malignancy, arthritis, or autoimmune diseases.

The following parameters were noted at ED triage: Temperature: 39.1 0 C HR: 123 bpm BP: 96/50 mmHg Muscle power: At least 3/5 Initial blood gas: pH-7.474, pCO 2 -63.9 and HCO 3 -24.9 Arterial blood gas P/F ratio: 78.6 Examination: Bilateral lung crepitations up to mid zone with no rhonchi, no focal CNS deficits The primary diagnosis was pneumonia (community-acquired), but she required high-oxygen support despite antibiotic therapy. Procalcitonin was in the normal…