35 year old with recent diagnosis of acute myelogenous leukemina is treated with induction chemotherapy with idarubicin and cytarabine. 3 weeks after induction chemotherapy he develops cough, dyspnea, hypoxemia, and fever with temperatures to 101.5.
Physical exam reveals a few crackles in the R lung, but is otherwise unremarkable.
Chest x-ray reveals a focal infiltrate in the R lung.
Routine sputum C/S is negative. 4 sets of blood C/S are negative. Patient is still febrile after 3 days of cefepime and vancomycin.
Laboratory testing is as follows:
Hb: 9.2 gm/dl
LFTS: Total protein: 4.9 TB: 0.8, Alk Phos 123, ALT 34, AST 27
Na: 137, K: 3.9, HCO3: 16 Cl: 118, BUN: 22, Cr: 0.9, Glucose: 98, Calcium 8.9