Atypical pneumonia presenting as hyponatremia: a case report

Atypical pneumonia is atypical in presentation with only moderate amounts of sputum, no consolidation, only small increases in white cell counts and no alveolar exudates; and sometimes, not even presenting with respiratory symptoms. Here we present a case of a 65 years old elderly man who presented with disorientation, hiccups and loss of appetite. He was a known diabetic and hypertensive. On presentation patient had a SpO2 of 96%. Lab reports were suggestive of severe hyponatremia of 92meq/L and clinically he was euvolaemic. Chest X-ray showed right sided consolidation. However he did not have any breathlessness or cough. He was given sodium correction and antibiotics for the consolidation and was treated as a community acquired pneumonia. Patient showed signs of improvement. All other causes for hyponatremia were ruled out. However, the patient again presented with same symptoms after 1 month with hyponatremia of 95meq/L and left sided consolidation. He was again given sodium correction. Patient did not produce sputum so bronchial lavage was done and sent for culture sensitivity which showed chlamydia infection. Antibiotics were given according to the sensitivity. Patient improved clinically. On follow up after 1 month patient had normal x ray and normal sodium levels. Hence repeated episodes of hyponatremia associated with pneumonia were hypothesized to be caused by atypical pneumonia caused by chlamydia- a rare presentation.