LAUSR

CASE PRESENTATION A 19yearold man presented to the ED for 1 week of fevers, headache, weight loss, and a nonproductive cough. The patient immigrated to the USA from Nepal 3 months previously. Approximately 7 to 10 days prior to presentation, he developed fever, night sweats, frontotemporal headaches and a nonproductive cough. He also endorsed rightsided chest pain with inspiration, poor appetite, and unintentional 3 kg weight loss in the past week. He denied haemoptysis, sensory or motor changes, abdominal pain, sick contacts or other significant previous medical history. On physical examination, he was well appearing with a normal blood pressure (111/67 mm Hg) and a heart rate of 104 bpm. He was afebrile (36.7 C) with a normal respiration rate. His examination was unremarkable aside from diminished breath sounds on the right. He was alert and oriented with no gross neurological deficits. The initial laboratory data were within normal limits aside from mild hyponatraemia (132 mmol/L, reference 136–145) and mild elevation in alanine transaminase (ALT) (93 U/L, reference 10–40) and total bilirubin (1.7 mg/dL, reference 0.1–1.2). A posteroanterior and lateral chest radiograph was performed showing a right lung base opacity and moderatesized, dense, pleural effusion. A dedicated CT chest was recommended for further evaluation.