A 61-year-old woman presents to the emergency room complaining of cough for 2 weeks. The cough is productive of green sputum and is associated with sweating, shaking chills, and fever up to 102F (38.8C). She was exposed to her grandchildren who were told that they had upper respiratory infections 2 weeks ago but now are fine. Her past medical history is significant for diabetes for 10 years, which is under good control using oral hypoglycemics. She denies tobacco, alcohol, or drug use. On examination, she looks ill and in distress, with continuous coughing and chills. Her blood pressure is 100/80 mm Hg, her pulse is 110 beats/min, her temperature is 101F (38.3C), her respirations are 24 breaths/min, and her oxygen saturation is 97% on room air. Examination of the head and neck is unremarkable. Her lungs have rhonchi and decreased breath sounds, with dullness to percussion in bilateral bases. Her heart is tachycardic but regular. Her extremities are without signs of cyanosis or edema. The remainder of her examination is normal. A complete blood count (CBC) shows a high white blood cell (WBC) count of 17,000 cells/mm3, with a differential of 85% neutrophils and 20% lymphocytes. Her blood sugar is 120 mg/dL. (At least 2 references not more than 3 years old).

 

1. What is the most likely diagnosis?

2. What is your next diagnostic step?

3. What is the next step in therapy?

4. What are potential complications of this diagnosis?