The Brief Case: Cough in an Immunocompromised Patient.

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We report a case of a 78-year-old female with a medical history of metastatic breast cancer receiving chemotherapy who presented to the emergency department (ED) in the summertime complaining of dizziness and a cough. She had recently been seen by her primary care provider for shortness of breath, at which time a left-sided infiltrate was noted on chest X ray. A 5-day course of oral azithromycin had been prescribed for community-acquired pneumonia (CAP). She failed to improve and did not complete the treatment, because she presented to the ED prior to the end of therapy. She reported decreased appetite, fatigue, and shortness of breath. On physical examination, she was afebrile and tachycardic, and diminished breath sounds were auscultated in the left base. The complete blood count was notable for the absence of leukocytosis. Blood cultures were sent, and a chest X ray revealed hazy opacities in the left upper lobe (Fig. 1). No other testing, including respiratory or molecular tests, was conducted at that time, and the patient left the ED against medical advice.