JW, a 41-year-old apple orchard worker, presented to his local physician with cough, fever, and sputum prroduction of 2 days' duration. Six hours earlier JW had a shaking chill and began to notice right-sided chest pain when he coughed. He has been feeling progessively weak. When questioned, JW denied hemoptysis but reported that for the last month he has had a decreased appetite and has lost 8 pounds, approximately 6% of his body weight. The patient has been able to work in the orchard every day. Remarkable in JW's history is that, on a routine employment physical examination 2 years ago, he was diagnosed with chronic myelogenous leukemia. He was asymptomatic at the time. Fifteen months ago, he had a bone marrow transplant from a human lymphocyte antigen-matched older brother. The physical examination was remarkable for egophony and rales at the right lung base, a temperature of 39.0°C, and a respiratory rate of 22. JW had a dry mouth, and skin examination showed a dry scaly rash over his arms. The remainder of the examination was within normal limits. What is the best course of action for diagnosis and treatment for this patient?.
|Original language||English (US)|
|Number of pages||4|
|State||Published - Jul 27 1998|