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Severe lower respiratory tract infection with no cure

45 y.o. male came from saffari tribe from West Africa. He had severe LRTI with productive cough and sometimes blood came with mucous. He took medicine for cough and antibiotics but with no results. He was advised to make a mucous culture and we found that he has a mixed infection between 3 types of bacteria; 2 of them were highly sensitive to imipenem (tienam vial) and the other one was highly sensitive to doxycyclines (vibramycin cap). The doctor prescribed tienam vial 3 times daily and vibramycin cap twice daily to cover the 3 species of bacteria for 7 days. After 7 days the patient came to the clinic and no positive result happened, he still suffered and the case worsened. Upon remaking the mucous culture, the 3 species of bacteria still exist.

Similar cases

58-y.o. male, smoker, with no medical history presented on ED for progressing dyspnoea, productive cough and weakness. Initial BP: 141/96mmHg, HR: 113/min., T: 36.5 °C, SatO2: 96% /6l O2 mask. Cold sticky sweat on the skin. X-ray showed serious inflammatory changes bilat. Initial CT-chest scan showed extensive consolidations with compressed to closed lobar and segmental bronchi. We administered ATB (Cefotaxime + Moxifloxacin) empirically. In blood culture, tonsils and urine (Ag) was detected S. pneumoniae sensitive to administered Atb. Despite that, on the 7th day of hospitalization, there were sudden worsening with serious respiratory failure and hypotension. X-ray and CT scans showed massive PTX, subcutaneous emphysema. Chest drainages were introduced.

67 years old male patient. He has HT and there isn't any other chronic disease. 50 days ago, he had rush and edema on his foot. After the edema, he had some scars like that. 7 days ago he had cough and orthopnea. Now he has HSM. Sedimentation: 51, CRP: 13.9. Cultures negative. We are checking for thrombophlebitis. Any ideas?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?