A 36-Year-Old Primigravida at 24 Weeks Gestation Comes to the Emergency

A 36-year-old primigravida at 24 weeks gestation comes to the emergency department due to dry cough and shortness of breath since last night.  The patient has a history of diabetes mellitus type 1 and mild, intermittent asthma.  Six days ago, she went to an urgent care clinic due to urinary frequency and dysuria and was started on nitrofurantoin.  The patient smokes 5 cigarettes daily, down from one pack daily prior to her pregnancy.  Temperature is 38.2 C (100.8 F) , blood pressure is 137/92 mm Hg, pulse is 104/min, and oxygen saturation is 92% on room air.  Lung examination reveals crackles at the bases bilaterally.  On cardiac auscultation, a 2/6 ejection-type murmur is heard at the left upper sternal border.  The extremities are warm to the touch.  There is 1+ edema of the ankles bilaterally.  Laboratory results are as follows: Chest x-ray reveals bilateral parenchymal opacities, predominantly in the mid and lower lung zones.  Which of the following is the most likely diagnosis?

A) Acute interstitial nephritis
B) Drug-induced lung injury
C) Peripartum cardiomyopathy
D) Preeclampsia
E) Pulmonary embolism
F) Pulmonary sarcoidosis

Correct Answer:

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