Diagnostic approach of pneumonia in an elderly patient with comorbidities--case report.

Dyspnea is one of the symptoms that has a major impact on pa-tients' health, with a negative influence on the quality of life. The main causes of dyspnea are cardiac, pulmonary and mixed (cardiac or pulmonary). There are several other causes such as metabolic conditions (acidosis), pain, neuromuscular disorders, otorhinolaryngeal disorders, anxiety, panic disorders and hyperventilation. Acute pneumonia in the elderly is a common occurrence and its incidence grows as the elderly population increases. We report the case of a 76 years old patient with a known cardiovascular condition, recently hospita-lized for right pulmonary infarction. He presented to our clinic for influenced general state, rest dyspnea, fever, shiver, and productive cough in the last two days. Current medication included oral anticoagulants and triple antihypertensive treatment (responsible for his low blood pressure). Laboratory results showed a nonspecific inflammatory syndrome with leu-kocytosis and neutrophilia and mild normochromic normocytic anemia; D-dimers were with-in normal range, fibrin degradation products 1+; myocardial enzyme testing showed no alte-ration, and BPN (beta natriuretic peptide) was 790 pg/ml. Chest X-ray showed diffuse bila-teral reticular shadows (more pronounced on the right side) and left costodiafragmatic opaci-fication. It appears that age-related increase in morbidity and mortality in community-acquired pneumonia is not due to age per se, but to interactions between the immune system, systemic diseases and nutritional factors. Community-acquired pneumonia in the elderly is known to have a high mortality. Although the diagnosis can be easy, the physician must also investigate for less obvious causes of dyspnea such as the presence of comorbidities and fra-gility of the elderly patient.