• Nicholas Quigley, Christian Couture, Philippe Gervais, and François Maltais.
• Departments of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, Quebec City, QC, Canada; Department of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. Electronic address: Nicholas.quigley.1@ulaval.ca.
• Chest. 2023 Mar 1; 163 (3): e111e114e111-e114.

AbstractA 37-year-old man attended a medical clinic at the confluence of the Appalachian and the St. Lawrence Valley after 2 weeks of coughing greenish sputum and progressive dyspnea on exertion. In addition, he reported fatigue, fevers, and chills. He had quit smoking a year earlier and was not a drug user. He recently had spent most of his free time outdoors, mountain biking, but had not travelled outside of Canada. Medical history was unremarkable. He did not take any medication. Upper airway samples taken for SARS-CoV-2 proved negative; he was prescribed cefprozil and doxycycline for presumed community-acquired pneumonia. He returned to the emergency room 1 week later with mild hypoxemia, persisting fever, and a chest radiography consistent with lobar pneumonia. The patient was admitted to his local community hospital, and broad-spectrum antibiotics were added to the regimen. Unfortunately, his condition deteriorated over the following week, and he experienced hypoxic respiratory failure for which he required mechanical ventilation before his transfer to our medical center.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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