Comment
This patient was vulnerable to pneumonia because of her age and her
underlying COPD. As in many elderly persons, her pneumonia presented
with vague symptoms such as fatigue and confusion. Her lack of fever,
which can be seen with pneumonia, reflects an inadequate immune
response to the infection and, again, was likely owing to her age. She
illustrates serious and common complications of pneumonia. She had a
sepsis-like picture with an overwhelming reaction that caused a fall in
blood pressure (shock). Sepsis and respiratory failure are major causes of
death in pneumonia patients. Fluid collection around the lung (pleural
effusion) and low oxygen levels are other common complications. The lack
of identified bacteria in cultures of pneumonia patients’ blood is common,
as bacteria may not be present in the blood at the precise moment when
the cultures are drawn, or their growth may be suppressed by prior
administration of antibiotics.