Mrs. G is an 80 yo woman nursing home resident who was broug…
Mrs. G is an 80 yo woman nursing home resident who was brought to the Emergency Room for a chief complaint of severe shortness of breath and fever. Two months prior to admission (PTA), she suffered a right cortical stroke and has left sided weakness. Three days PTA she was noted to be coughing heavily and was intermittently bringing up yellow, foul smelling sputum. She was also noted to have a fever = 39 degrees C.Two days PTA, she began complaining of chest pain on inspiration. The day of admission she complained of severe shortness of breath and was noted to have an increased respiratory rate. PE: BP 85/60, P125, RR 35, Temp 40 degrees C. Oxygen saturation on room air is 90% Gen: Very ill appearing elderly female in acute respiratory distress. HENT: Teeth in poor repair, poor dental hygiene with multiple carries and severe gingivitis. Lungs: Decreased breath sound right posterior lung field 1/3rd up the lung field. Dullness to percussion lower 1/3rd of the right posterior lung field. Neuro exam: Alert oriented, dense left hemiparesis, poor gag response LAB: WBC 14,000 (65% PMN 10% bands, 25% Lymphs) Comment: elevated WBC CXR: Infiltrate noted in the RLL, as well as an area of higher radio-density in the lower 1/3rd of the same lung field suggestive of pleural fluid. What is the likely cause of her pneumonia?