Case history/examination
A 67-year-old male patient was admitted to our hospital with complaints of continuous and gradually worsening shortness of breath, fever, productive cough, headache, loss of apetite, and weight loss since 1.5 months ago which got worse 15 days prior to admission. Meanwhile, he had visited the outpatient clinic several times and had no improvement. He was a chef from a city from north of Iran with 5 children. Medical history revealed inguinal surgery for hernia,10 years ago and prostate surgery, 1 year ago. His social history, familial history and drug history were unremarkable, except seretide and salbutamol that were started in 15 recent days. The physical examination revealed a somnolent patient with 13/15 score on the Glasgow coma scale, who was febrile (T:38.8 °C) and had BP:90/60, RR:32 breaths/ min, PR:98 breaths/ min. He was in respiratory distress and required oxygen therapy to maintain saturation, so that his O2 saturation was 76% while he was breathing ambient air and with mask 92%. Severe thrush was detected in the oropharynx. In addition, bilateral crackles were detected on pulmonary auscultation.