a 37 years old woman with increasing confiusion, shortness of breath, fever and chills.
history of present illness:
the patient was a case of IDDM since 10 years relatively well till 3 months ago when she developed weakness, fever and dyspnea. she received broad spectrum antibiotics aftwer az initial laboratoy work up at alocal hospital. her hospital course was further complicated by an inferior wall myocardial infarction. after relative improvement she was then discharged home on intra venous antibiotics via a long-term peripheral intravenous line. now she presernted to the emergency room with compliants of shortness of breath. fever and chills along with increasing confusion.
past medical history:
bening breast mass
she is singel. she has a history of 10n pack year smooking.