The following day on rounds.

• Naomi is in mild respiratory distress,
• Complains of hotness of body and
• Chest tightness.
• Vital signs: Temp = 38.2°C, Pulse = 90, BP = 100/60, Resp = 26.
• Pulse ox reveals a biox of 86%.
• Chest exam now reveals course breath sounds bilaterally.
• She still ahs oral thrush.
• Her hemogram reveals a pancytopenia.
• ELIZA results won't be back for several days.

With the help of family members, she is able pay for a chest X-ray. Click here for larger X-ray image. Naomi has PCP When an immunosuppressed patient is started on Septrin, this can 'unmask' Pneumocystis carinii pneumonia, leading to fever and hypoxia. Why?

Photo courtesy of NIH

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