An unusual presentation

At a birthday party on Saturday, one of my friends left early because she didn't feel well. I asked her what was wrong, and she said she didn't know, she was exhausted and had been fainting a lot lately. Although my friend has a tendency to be rather melodramatic (going to the ED because the back of her throat looked funny; she didn't feel ill) and she also faints every time she sees blood or has blood taken, this sounded a little strange even for her.

My wise nursing skills came into play and I strongly encouraged her to go see a provider or at least call a doctor. She kept asking me what could be causing it and why I was worried. However, as I was at a party, I didn't feel like playing let's list and explain the differentials. My strong nursing and NCLEX pass skills came into play and my first thought and reason for going to her provider was "safety." Regardless of the cause, it is dangerous to be randomly losing consciousness. You can hit your head, crash your car, etc.

Leaving the restaurant, my friend evidently fainted again outside her car. Finally she went to the ED either that night or Sunday. What was her diagnosis? Pneumonia. I never would have guessed. Her only other sign was "not feeling right." She had no fever, chills, cough, shortness of breath or chest pain. Today, she wasn't able to keep down her antibiotics and started coughing up bloody mucus, so she went back. I'm still waiting to hear if anything has changed.

Great reminder that diseases often don't present classically and that it is much more likely to be an uncommon presentation of a common illness than a common presentation of an uncommon illness.