Pulmonary Examination Clear Breathing Sounds Amidst Feverish Symptoms

Introduction:

In medical practice, a thorough physical examination is crucial in diagnosing and treating patients. One such examination involves listening to the lung sounds using a stethoscope. In this article, we will discuss a case where a patient presents with fever and clear breathing sounds on pulmonary examination, raising questions about the potential underlying causes and treatment approaches.

Case Presentation:

A 35-year-old male presented to the emergency department with a chief complaint of fever for the past three days. The patient reported a feverish sensation, chills, and general malaise. He denied any cough, shortness of breath, or chest pain. His vital signs were as follows: temperature of 39.2°C (102.6°F), heart rate of 92 beats per minute, respiratory rate of 16 breaths per minute, and blood pressure of 120/80 mmHg.

Upon physical examination, the patient's lung sounds were clear to auscultation bilaterally. No wheezes, ronchi, or rhonchi were noted. No signs of consolidation, pleuritic chest pain, or increased respiratory effort were observed. The patient's heart sound was regular, and the rest of his examination was unremarkable.

Initial Considerations:

The presence of fever without any respiratory symptoms suggests a systemic infection. The clear lung sounds raise the possibility of a viral illness, such as influenza, or a non-pulmonary source of fever. To further evaluate the patient's condition, we considered the following differential diagnoses:

1. Viral Infection: The patient's fever, chills, and general malaise are consistent with a viral infection. The clear lung sounds suggest that the infection is not localized to the lungs.

2. Bacterial Infection: Although less likely given the clear lung sounds, a bacterial infection, such as streptococcal pharyngitis, could still be a possibility.

3. Non-Pulmonary Sources of Fever: The patient's fever could be due to an unrelated condition, such as a urinary tract infection, appendicitis, or an inflammatory disorder.

Investigations and Treatment:

To further evaluate the patient's condition, we ordered the following investigations:

1. Complete Blood Count (CBC): The CBC revealed a leukocytosis with a left shift, indicating a possible infection.

2. Urinalysis: The urinalysis was negative for leukocyte esterase and nitrites, ruling out a urinary tract infection.

3. throat culture: The throat culture was negative for group A Streptococcus, excluding streptococcal pharyngitis.

Given the patient's clinical presentation and investigations, we initiated treatment with oseltamivir, an antiviral medication used for the treatment of influenza. We also advised the patient to rest, stay hydrated, and manage his fever with over-the-counter medications such as acetaminophen.

Follow-Up and Outcome:

The patient was discharged with instructions to follow up with his primary care physician in one week. At his follow-up visit, the patient reported significant improvement in his symptoms. His fever had resolved, and he was feeling better overall. A repeat CBC showed normalization of the white blood cell count, and further investigations were not necessary.

Conclusion:

In this case, the presence of fever and clear breathing sounds on pulmonary examination led to a differential diagnosis of a viral infection. By ordering appropriate investigations and initiating treatment, we were able to effectively manage the patient's condition. This case highlights the importance of a thorough physical examination and the use of investigations to guide treatment decisions in clinical practice.