A 36 year old cattle farmer was admitted to hospital with a flu like illness. 3 days after admission he developed arthralgia and  progressive shortness of breath. There was a soft systolic murmur over the precordium. Chest X-Ray showed bilateral infiltrates.

ECG showed non-specific ST-T changes. Troponin raised. Echo revealed decreased LV function.

Hb 90 G/L.

Reticulocytes 4% (0.5-2).

List  5 differential diagnoses for his presentation

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College Answer

a)  Viral pneumonia

b)  Legionella

c)  Pneumococcal

d)  Q fever

e)  Mycoplasma

f)   Infective endocarditis

g)  Leptsopirosis

h)  Brucellosis

i)    Vasculitis (unlikely)

Discussion

This question closely resembles Question 25.4 from the second paper of 2009.