CASE VIGNETTE

A 42-year-old sweeper from Northern India presented with progressive dyspnea for the past 3 weeks. One month prior this presentation, he had a 5-day history of fever with chills and a 4-day history of productive cough with yellowish sputum. He was treated empirically with amoxicillin-clavulanate and doxycycline, which led to a reduction in fever intensity. His medical history was significant for recently diagnosed diabetes mellitus (HbA1c: 11.5%).  He is a non-smoker but chews tobacco and consumes alcohol socially. 15 days into the illness, the patient sought medical attention at a private hospital for increased dyspnea, where a chest X-ray was performed. An intercostal chest drain (ICD) was inserted, and haemorrhagic pleural fluid was drained. He was treated with cefpodoxime and a respiratory fluoroquinolone. Subsequently, the patient left against medical advice, the ICD was removed, and he was later presented to our hospital. Chest x-ray (figure 1) showed hydropneumothorax and frank pus was aspirated.

Table 1: Relevant preliminary investigations of the patient