MRCP2-2928

MRCP2-2928

A 30-year-old farmer presents to the Emergency Department with a one week history of lethargy and subjective pyrexia. Over the past 24 hours he has developed left sided pleuritic chest pain which brought him to hospital.

He denies any past medical history and had been systemically well prior to this. He denies any recent overseas travel.

Examination reveals left sided coarse crackles in the lungs, there is no abnormality heard in the right side of the lung.

His observations revealed heart rate 100 beats per minute, oxygen saturation 97% in room air, temperature 38.2ºC, respiratory rate 20 breaths per minute, blood pressure 140/90 mmHg.

An ECG was performed which revealed sinus tachycardia and his chest radiograph revealed left sided consolidation.

His blood results taken on admission were as follows:

Hb 142 g/L Male: (135-180)
Female: (115 – 160)
Platelets 450 * 109/L (150 – 400)
WBC 15 * 109/L (4.0 – 11.0)
Na+ 141 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 5.5 mmol/L (2.0 – 7.0)
Creatinine 105 µmol/L (55 – 120)
CRP 160 mg/L (< 5) Bilirubin 15 µmol/L (3 – 17)
ALP 80 u/L (30 – 100)
ALT 75 u/L (3 – 40)
γGT 50 u/L (8 – 60)
Albumin 42 g/L (35 – 50)

What is the most likely diagnosis?