I'm having severe chills



48 yo female with history hypertension and AML on chemotherapy presents to the hospital with 2 days of fevers, chills and severe fatigue. He was diagnosed with AML 2 weeks ago and has been started on a chemotherapy regimen which she has tolerated well thus far.


Starting 2 nights ago she began having chills in the evenings that improved with ibuprofen and a warm shower. She checked her temperature and it was 99.4. Her symptoms continued and she came to the hospital.


She denies nausea, vomiting, diarrhea or dysuria but does have mild nonproductive cough.


VITALS

T 101.2 HR 112 BP 110/83 SPO2 98% on room air RR 18


EXAM

Gen: in no distress, resting comfortably

CVD: tachycardic, 2/6 systolic murmur

Lungs: Clear to auscultation; some mild rhonchii in left lung

Abd: Soft, nontender, bowel sounds present

Extremities: no lower extremity edema or erythema


RELEVANT LABS


WBC 0.2, ANC 390

Hgb 9

Plt 100k


BUN 18

Cr 1.0


POCUS EXAM


Left and right anterior lung fields


Left lower lobe


Left lower lobe (down one rib space from above)


Left lower lobe pleural line (zoomed in)


What is the diagnosis?


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