Any medical types out there?

I'm desperate!! Please help.
I have a case study due for school. What is the medical dx?

Patient: 42y/o, SOB, underweight, high WBC & BUN & PB. Anxious, in & ex wheeze, weak, dry cough. Dyspnic, tachycardia & pnea, temp 102.2. Cool & clammy. Hyptoactive bowel.

Here's my thinking:
Pneumonia - no because cough is usually productive and not wheezing like in case study.

TB - maybe, but usually crackles and chest pain, but not in study.

PE- tachypenia, dyspnea & anxiety fit, but what are breath sounds with PE? Why a fever if PE?

COPD - cough is usually productive. Why would pt have fever & high WBC?

Asthma - fits best with the presentation, but wheeze is more common on expiration. More important, why does the pt have the fever, high WBC & high BUN?

Bronchitis has a productive cough.

BUN can be kidney, sepsis, excess protein consumption, starvation, dehydration, or cardiac failure.
Pt is very thin. Can BUN be due to starvation & starvation due to dyspnea? But why fever

Good start on a DDx. My thoughts:

Meets all four criteria for Systemic Inflammatory Response Syndrome (SIRS - usually need 2/4). 1) High WBC; 2) Tachycardia; 3) Tachypnea; 4) High temperature. Further, "cool and clammy" and high BUN make me think he's in shock (systemic hypoperfusion of tissues). A blood pressure would be nice confirmation. With that...

Pneumonia - entirely possible. Could have led to septic shock with the picture presented.

TB - TB can present like damn near anything. Not bad to include it in the DDx, particularly with pulmonary involvement and indicators of chronic disease (underweight). Can predispose to other infection, sepsis, and the above; can cause adrenal insufficiency and get to shock that way; can get to this picture about ten other ways a well.

Other possibilities:

Myocardial infarction: can cause SIRS and cardiogenic shock, which would account for the shock-like symptoms. Usually would present with chest pain but not always. Left ventricle infarction would lead to pulmonary edema and the pulmonary finds.

Sepsis of any source (not just pneumonia) could also present like this.

Overall, I like an infectious process of some kind for this, but it could be due to any of the many inducers of SIRS.

The pt can have more than one dx. He's pretty young for COPD, need more hx for TB, what's the background and exposure? My guess is a flu with underlying asthma.

I would go with Pneumonia.
Fever can cause dehydration if it's been going on for a while which would cause the BUN to go up. WBC will be high due to the infection.
Pt is thin doesn't mean it is related to the current problem. Could be thin normally.

May have an underlying disease process like emphysema which will cause underweight status, plus pneumonia will cause the other symptoms.

SOunds like a case for HOUSE-- no seriously- could be PCP (Pneumocystis ) with HIV, also fungal infection (aspergillosis),

Good luck-

If he's got a high WBC and fever, he's got an infection. Maybe he's got a real bad kidney infection too.

Definitely not pneumonia, I had it once and after the initial fever my temp was normal.

cardiac asthma with sepsis?