The role of general practitioners in the diagnosis of community-acquired pneumonia of atypical presentation: a case report
DOI:
https://doi.org/10.32385/rpmgf.v40i4.13899Keywords:
Pneumonia, Primary health care, Differential diagnosis, Back painAbstract
Introduction: Community-acquired pneumonia (CAP) is one of the most common diagnoses in clinical practice, an important reason for unscheduled consultations in primary health care and emergency departments, with an increasing incidence in recent years. In patients with chronic comorbidities, the suspicion threshold should be even lower, as the form of presentation is often different from the classic one.
Case description: We present the case of a 39-year-old man with a previous history of diabetes and cardiovascular disease, who attended the emergency department for low back pain and fever and was diagnosed with renal colic. He subsequently consulted his primary care physician, to obtain a prescription for an imaging examination. However, due to persistent low back pain, fatigue, dyspnea, and crackles in the left lung base, we considered the alternative diagnostic hypothesis of community-acquired pneumonia. The patient was treated empirically with amoxicillin 1000mg every 8 hours for seven days, together with azithromycin 500mg 1id for five days, and a chest X-ray was ordered. The patient had no complaints at the reassessment visit and was clinically stable.
Comment: The main goal of this case report is to raise awareness of the less common presentations of pneumonia in primary healthcare and to state the importance of quality post-hospital care follow-up, which works as a safety net, ensuring favorable clinical outcomes and early detection of possible complications.
Downloads
References
World Health Organization. Pneumonia [homepage]. Geneva: WHO; s.d. [cited 2023 Feb 1]. Available from: https://www.who.int/health-topics/pneumonia#tab=tab_1
Sociedade Portuguesa de Pneumologia. Sociedade Portuguesa de Cardiologia [homepage]. Lisboa: SPP; 2020 [cited 2023 Feb 3]. Available from: https://www.sppneumologia.pt
Centers for Disease Control and Prevention. NAMCS/NHAMCS – Ambulatory Health Care Data Homepage [homepage]. Washington: CDC; 2023 [cited 2023 Feb 3]. Available from: https://www.cdc.gov/nchs/ahcd/index.htm
Quan TP, Fawcett NJ, Wrightson JM, Finney J, Wyllie D, Jeffery K, et al. Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014. Thorax. 2016;71(6):353-42.
Gardete-Correia K, Boavida JM, Raposo JF, Mesquita AC, Fona C, Carvalho R, et al. First diabetes prevalence study in Portugal: PREVADIAB study. Diabet Med. 2010;27(8):879-81.
Pahal P, Rajasurya V, Sharma S. Typical bacterial pneumonia [Internet]. Treasure Island: StatPearls Publishing; 2023 [cited 2023 Feb 3]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534295/
Metlay JP, Schulz R, Li YH, Singer DE, Marrie TJ, Coley CM, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997;157(13):1453-9.
Crain N. Renal colic mimics: differential diagnosis and approach to management. In: emDocs [homepage]; 2018 Nov 8 [cited 2023 Feb 4]. Available from: http://www.emdocs.net/renal-colic-mimics-differential-diagnosis-approach-management/
Minotti B, Treglia G, Pascale M, Ceruti S, Cantini L, Anselmi L, et al. Prevalence of microhematuria in renal colic and urolithiasis: a systematic review and meta-analysis. BMC Urol. 2020;20(1):119.
Pahal P, Rajasurya V, Sharma S. Typical bacterial pneumonia [Internet]. Treasure Island: StatPearls Publishing; 2023 Jul 31 [updated 2024]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534295/
Wootton D, Feldman C. The diagnosis of pneumonia requires a chest radiograph (x-ray)-yes, no or sometimes? Pneumonia (Nathan). 2014;5 Suppl 1:1-7.
Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64 Suppl 3:iii1-55.
Sociedade Portuguesa de Pneumologia. Recomendações de abordagem diagnóstica e terapêutica da pneumonia da comunidade em adultos imunocompetentes [Portuguese Respiratory Society guidelines for the management of community-acquired pneumonia in immunocompetent adults]. Rev Port Pneumol. 2003;9(5):435-61. Portuguese
Cooke J, Butler C, Hopstaken R, Dryden MS, McNulty C, Hurding S, et al. Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI). BMJ Open Respir Res. 2015;2(1):e000086.
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-67.
Hamilton W. The future of diagnosis in general practice. Br J Gen Pract. 2020;70(696):319-20.
Bergman A, Hjelmgren J, Ortqvist A, Wisløff T, Kristiansen IS, Högberg LD, Persson KM, Persson U. Cost-effectiveness analysis of a universal vaccination programme with the 7-valent pneumococcal conjugate vaccine (PCV-7) in Sweden. Scand J Infect Dis. 2008;40(9):721-9.
Savoy M, Hazlett-O’Brien C, Rapacciuolo J. The role of primary care physicians in managing chronic disease. Dela J Public Health. 2017;3(1):86-93.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
