Dyspnea Secondary to Pneumonia with Suspected Acute Cardiogenic Pulmonary Edema Secondary to Heart Failure

Abstract

Pneumonia remains one of the leading causes of morbidity worldwide and may present with clinical features that overlap with cardiogenic pulmonary edema secondary to heart failure. Distinguishing these conditions in primary healthcare can be challenging because of limited diagnostic resources, making appropriate clinical assessment and timely referral essential. A 51-year-old man presented to a rural primary healthcare facility with progressive dyspnea, productive cough, fever, and exertional fatigue. Physical examination revealed tachypnea, oxygen desaturation, bibasal coarse crackles, and suspected cardiomegaly. Laboratory findings demonstrated leukocytosis. Chest radiography suggested acute pulmonary edema with suspected pneumonia and cardiomegaly. The patient received supplemental oxygen, intravenous ampicillin, nebulization, corticosteroids, antipyretics, and supportive therapy. Referral to a higher-level hospital was strongly recommended. However, the patient declined referral and requested discharge against medical advice on the second day of hospitalization. This case emphasizes the diagnostic complexity of pneumonia and acute cardiogenic pulmonary edema in resource-limited primary healthcare settings. Comprehensive clinical assessment, appropriate initial stabilization, and evidence-based management remain essential. Timely referral is crucial for definitive diagnosis and specialist care, although patient refusal may limit therapeutic options and potentially affect clinical outcomes.