Diagnostic Challenges of Pneumonia in an Elderly Patient Presenting with Acute Chest Pain: A Case Report

Abstract

Community-acquired pneumonia in older adults often presents with atypical clinical manifestations, which may complicate diagnosis, particularly when patients present with acute chest pain. A 71-year-old man presented to the Emergency Department with left-sided chest pain described as a heavy pressure radiating to the neck and back, beginning six hours before hospital admission. The complaint was accompanied by nausea and a one-week history of cough without fever. Physical examination revealed a blood pressure of 160/100 mmHg and crackles in both lung fields. Electrocardiography showed ST-segment depression in the lateral leads. Laboratory examination revealed leukocytosis without an increase in CK-MB, while chest radiography showed an infiltrate in the right parahilar-paracardiac region consistent with pneumonia. The patient was diagnosed with Killip class I unstable angina pectoris accompanied by community-acquired pneumonia and received treatment for both conditions. This case demonstrates that pneumonia in older adults may present with atypical symptoms resembling acute coronary syndrome. A systematic diagnostic approach is necessary to identify both conditions accurately and determine appropriate management.