Volume 360:1770-1779 April 23, 2009 Number 17
Michael E. Weinblatt, M.D., Gerald F. Abbott, M.D., and Aashiyana F. Koreishi, M.D.
Presentation of Case
A 54-year-old woman was admitted to the hospital because of respiratory failure, hypotension, and a cavitary lesion in the lung.
She had rheumatoid arthritis but had otherwise been well until approximately 1 week before admission, when upper respiratory symptoms, cough, and shortness of breath developed. On the day of admission, shortness of breath worsened. She called her physician, who advised her to go to a hospital for evaluation. While she was preparing to leave her home, her symptoms increased in severity; she collapsed, and emergency medical services (EMS) were called.
When they arrived, the patient was unconscious and showing minimal . . .
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