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This is a case of partially-treated, community acquired pneumonia (CAP), presenting with severe complications of parapneumonic effusion, empyema, hemolytic anemia and pancytopenia. Common pathogens of CAP that may present with hemolysis include mycoplasma and, less commonly, strep pneumonia with hemolyticuremic syndrome. Pathogens that cause atypical pneumonia tend to produce more extra pulmonary manifestations than occurs in typical pneumonia. Atypical pneumonia can pose a diagnostic challenge for clinicians since there are no diagnostic tests for reliable and early detection of atypical organisms and since partial treatment of CAP with antibiotics may mask important clinical signs. Serologic tests, including ELISA, indirect fluorescent antibody assay and particle agglutination to detect IgM and IgG, are increasingly used to diagnose atypical pneumonia. Although these tests may aid in the identification of the pathogen, delayed results and economic burden are significant barriers and they seldom help in early management decisions, including empiric antibiotic coverage. The 2007 IDSA/ATS consensus guidelines recommend diagnostic testing for a specific organism only when empiric antibiotic therapy fails to result in clinical improvement. Diagnostic testing for outpatient management of CAP is considered optional.
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