History: 49-year-old male with PMH significant for end stage renal disease s/p external arteriovenous shunt placement for home dialysis presents with complaint of 3 days of fevers, chills, nausea, vomiting, anorexia, cough and pleuritic chest pain. Patient had similar signs and symptoms 1 year, was found to have MSSA bacteremia with septic pulmonary emboli. Following shunt replacement and antimicrobial therapy he demonstrated improvement. Denies tobacco, alcohol or illicit drug use. No family history of pulmonary disease or cancer
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