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On Being a Doctor |

Discovery at the Bedside

Ohad Oren, BS
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From The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, 31096, Israel.

Acknowledgment: The author thanks Dr. Yoav Turgeman for the unparalleled dedication and teaching that inspired him to write this essay.

Requests for Single Reprints: Ohad Oren, BS, The Ruth and Bruce Rappaport Faculty of Medicine, Efron Street, P.O.B. 9649 Bat Gaim, Haifa 31096 Israel; e-mail, ohadoren@gmail.com.

Ann Intern Med. 2011;155(9):643. doi:10.7326/0003-4819-155-9-201111010-00017
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Recently, I was assigned to care for a 15-year-old girl with ataxia telangiectasia, the debilitating neurodegenerative disease that lacks an adequate DNA repair mechanism. The girl's documents revealed a history of repeated hospitalizations for pulmonary infections. Most recently, during a 10-day course of unremitting pneumonia, ciprofloxacin-resistant Pseudomonas aeruginosa was cultured from her sputum. This time, the patient's symptoms included a temperature up to 39.5 °C accompanied by greenish productive cough, shortness of breath, and pleuritic chest pain for the past 3 days. On auscultation of her lungs, I noticed decreased breath sounds on the right, and wet rales could be heard diffusely. Routine blood tests supported an infectious origin. With ataxia telangiectasia being a cancer-prone genetic condition, the use of ionizing radiation was to be restricted. We opted to do chest radiography only when absolutely necessary rather than to provide a baseline cardiothoracic window. Yet, even without imaging to confirm our presumptive diagnosis, pneumonia was the most reasonable explanation for her symptoms. We started therapy with the same medications that had worked for the patient during her last hospitalization, but to cover atypical organisms, we also sent a sample of her sputum to the laboratory.





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