Unmasking of poorly controlled diabetes mellitus by pulmonary nocardiosis

Description 

A 60-year-old Indian woman, known case of hypertension with no other comorbidities, presented with productive cough since 20 days and high-grade fever since 5 days. She also had breathlessness since 10 days which was insidious in onset, was initially exertional and had progressed such that it was now present at rest. There was no history of tuberculosis. Her appetite had been significantly reduced since 20 days prior to presentation.

On examination, she was tachypnoeic with a respiratory rate of 30/min, tachycardic with a pulse rate of 140/min, febrile with a temperature of 101°F. Her blood pressure was normal. Oxygen saturation was 91% on room air. Coarse inspiratory crackles could be heard in bilateral infra-axillary and infrascapular areas and the right infraclavicular area.

Chest X-ray showed consolidation in bilateral lower and mid zones and a well-demarcated homogenous opacity in right upper zone (figure 1), suggestive of...

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