PMC8339220_01
CRP and temperature charting and relationship to doxycycline and prednisone prescribing. MV, mechanical ventilation; Dx, diagnosis of psittacosis made via serology and PCR testing.
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On presentation the patient was febrile at 39.0  C (Fig. 1) with an oxygen saturation of 94 % on room air, but otherwise normotensive and neither tachypnoeic nor tachycardic.
Serial chest x-rays; A - hospital day 1: consolidation in the left lower zone with a moderate left-sided pleural effusion, B - hospital day 5: near complete consolidation of the left lung with pleural effusion, new consolidation in the right upper lobe, C - hospital day 5 (after first intubation): rapidly worsening and severe bilateral consolidation, D - hospital day 21 (re-intubation): diffuse bilateral airspace opacification, E - 1 month follow up: diffuse bilateral reticulations, right sided hydropneumothorax, corticosteroids ceased, F - deterioration at 3 months post discharge: recurrence of bilateral airspace opacification and small left pleural effusion.
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Chest x-ray (CXR) confirmed consolidation in the left lower zone with a moderate left-sided pleural effusion (Fig. 2). His CXR had progressed with near complete consolidation of the left lung with pleural effusion and new consolidation in the right upper lobe (Fig. 2); confirmed with computed tomography (CT) (Fig. 3). Despite another 6 days of doxycycline therapy the patient continued to deteriorate with extensive multi-lobar consolidation (Fig. 2).
Serial chest computed tomography; A - hospital day 2: consolidation left lower lobe with moderate pleural effusion, B - hospital day 5: severe bilateral consolidation with bilateral pleural effusions, C - hospital day 17 and D - hospital day 19: both show worsening airspace consolidation with areas of ground-glass appearance, migratory infiltrates and pleural effusions, E - 1 month follow up: improvement in the extent of consolidation, moderately pronounced bilateral pulmonary infiltrates, new areas of subpleural opacity in both upper lobes, loculated right sided hydropneumothorax likely secondary to a bronchopleural fistula.
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At follow up one month later, the patient was still desaturating on exertion and though repeat CT demonstrated improvement in the extent of consolidation, there were some new subpleural infiltrates, an area of associated traction bronchiectasis and a persistent right sided hydropneumothorax, likely secondary to a bronchopleural fistula (Fig. 3).