申論題

An 18-year-old girl was admitted to the hospital because of chest pain, fever, and chills for a couple of days. On the day of admission, cough with blood-tinged sputum were also noted. She worked as a waitress in a night-club. She appeared acutely ill; body temperature was 39.4℃, respiratory rate 30/min, pulse rate 110/min, and blood pressure 112/70 mmHg. Chest auscultation revealed coarse rhonchi over lung fields bilaterally. A grade 2/6 systolic murmur was audible along the left sternal border. Liver & spleen were not palpable. Examination of the extremities showed tracks of needle injection marks along the antecubital veins on forearms. There was no leg edema. A chest-x-ray showed bilateral multiple patch infiltrations over lung fields. Blood cell counts showed white blood cell 22,000/mm3 , red blood cell 3,000,000/mm3 , hemoglobin 9 g/dL, hematocrit 31%, platelets 189,000/mm3 ; differential counts showed segment 80%, lymphocyte 16%, monocyte 2%, eosinophil 1%, and basophil 1%. Urinalysis showed 4+ protein, as well as red blood cell and white blood cell casts. Blood urea nitrogen (BUN) was 40 mg/dL, creatinine 2 mg/dL, sugar 112 mg/dL, sodium 143 mEq/L, and potassium 3.3 mEq/L. What is your diagnosis? What is your plan? (20%)