Atypical Presentation of Pneumonia Mimicking Pulmonary Embolism

This case report highlights the diagnostic challenge arises from the varied clinical presentation, complicating the differentiation between infarction pneumonia, community-acquired pneumonia (CAP), and pulmonary embolism (PE). The author reports a female patient in her late seventies who presents with worsening right-sided pleuritic chest pain, exertional dyspnoea, and productive cough. She was initially treated for CAP with oral amoxicillin 500 mg QDS and clarithromycin 500 mg twice daily for 5 days. She denied any night sweats or weight loss. On lung auscultation, she had right lower lobe crepitations. Subsequently, she underwent a computed tomography pulmonary angiography (CTPA) to rule out PE which demonstrated filling defects in the right pulmonary artery and right lower lobe patchy consolidation. The patient was treated with rivaroxaban 15 mg BD for 21 days followed by 20 mg OD for 4 months, and also treated for CAP with ceftriaxone 2 g OD for 7 days.