1. A 67-yr-old woman with dyspnea and right pleuritic chest pain Nonsmoker 1 주 전 ; cough,sputum, sudden onset dyspnes, Rt. Pleuritic chest pain 으로 local 방문  chest X-RAY 상 Rt. lung 에 hazziness (+) Dyspnea aggravation, chest X-RAY 에서 병변 더욱 악화, local H 입원 –diagnostic thoracentesis; pH 7.339 WBC 4590 (neutro 95%, lymph 5%), protein 4 –cytology smear : acute& chronic inflammation –intermittent hemoptysis (+) fever(+) 3 일전 ; cbc 상 Platelet 40,000 으로 감소  * thoracentesis 결과 AFB(-) G(+) cocci  initial cefotaxime+ icefacin 사용 후 2 일 전부터 meropenem 으로 Change  ICU care 중 호전없고 진행하는 양상보여 SMC ER 로 전원됨 –intial V/S 134/71- 104/32- 36.9'C –* ABGA: 7.518-40.0- 53.8- 31.8- 91.0 –* lab: wbc 15200-13.3- 54K ( ESR 91, CRP 30.52) –Na-k-cl 131-3.6- 92 NT- proBNP 235

2. 19901005 A large soft tissue density in right middle and lower lung zones

3. Multilobal mass-like consolidation in right and left lungs

4. GUN biopsy: Necrotizing inflammation infarction

5. GUN biopsy: Necrotizing inflammation infarction (septic emboli, septic vasculitis)