Osler Round 1 - 60/M with persistent DIB

The clinical case

Mr. Kato, a 60-year-old male farmer from the rural district of Kamuli in Uganda, presented to the emergency department at Kamuli General Hospital after a 2-week history of progressive difficulty breathing. His symptoms worsened at night, and he experienced coughing fits, especially when lying down. Mr. Kato had been seen by a traditional healer initially, who prescribed him local herbs, but his condition did not improve. He has a known history of hypertension but has not been adherent to his medication due to financial constraints. Upon arrival, his vitals were: BP 180/100 mmHg, HR 110 bpm, RR 24 breaths/min, SpO2 92% on room air, and temperature 37.5°C. Physical examination revealed bilateral basal crackles on lung auscultation and a mild epigastric tenderness. Initial investigations included a complete blood count (CBC), which showed leukocytosis (WBC 12,500 cells/μL), a random blood glucose of 25 mmol/L, and a urine dipstick positive for ketones. Chest radiographs were clear.