This is the story of a typical teenage boy with pneumonia that turned out to be anything but typical. He presented to our emergency department with a five-day history of malaise and a three-day history of cough, fever, and progressively worsening shortness of breath. His initial vital signs were a temperature of 38.7° C, with a heart rate of 110, blood pressure of 109/77 and an oxygen saturation of 90% on room air.
On physical exam the patient exhibited increased work of breathing with scattered wheezing and crackles throughout both lung fields. Tests revealed that his initial white blood cell count was 22,000 with 79% neutrophils, 10% eosinophils, 6% lymphocytes, and 5% monocytes, hemoglobin of 15 and platelets of 339. Electrolytes and liver function tests were normal.