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A healthy 53–years-old male presented to ED with fever and arthralgia for two days.
On admission the patient was alert, oriented, febrile; thoracic exam revealed crackles
in left basal area. Blood exams showed lymphocytopenia (490/mmc), thrombocytopenia,
increased C-reactive protein (263 mg/l) with procalcitonin 0.37 ng/ml; chest CT scan
revealed multifocal pneumonia (Fig.1a). Blood cultures and urinary antigen test for Legionella were performed, the last
was negative. Empiric therapy with piperacillin-tazobactam and levofloxacin was started.
Fig. 1a: chest CT scan revealing multifocal lesions. b: chest CT scan one day later showing
worsening and tendency of cavitation
