Severe respiratory illness in an intravenous drug abuser

A 36-year-old female presented with a 3-day history of increasing shortness of breath, cough with purulent sputum, haemoptysis, pleuretic chest pain, nausea, vomiting and rigors. The patient was an intravenous drug user (IVDU) who smoked 20 cigarettes per day and denied drinking alcohol. Her only past medical history was of mild asthma, for which salbutamol was taken as needed. On examination, the patient appeared distressed and unwell. Her temperature was 39.3°C, and she was tachycardic (110 beats per minute), hypotensive (98/74 mmHg) and hypoxic (O2 saturation 86% on air with a respiratory rate of 20 breaths per minute). There were needle marks in both groins and forearms. Heart sounds were normal with no murmurs. A chest examination showed only decreased breath sounds at both bases. Abdominal and neurological examinations were unremarkable.