Case 37-2001

Presentation of CaseA 76-year-old man was admitted to the hospital because of atrial fibrillation and increasing dyspnea.The patient had been well until three weeks earlier, during an unseasonably warm period in late autumn, when a nonproductive cough without fever developed. Nine days later, the cough became productive, although the patient remained afebrile. Azithromycin was prescribed, but fever and chilliness developed, with nausea, vomiting, anorexia, mild bitemporal headache, and abdominal pain. He stopped taking the azithromycin after four days.Three days before admission, the patient went to a local hospital, where the temperature was 37.9°C and conjunctival injection was . . .