Influenza Quiz: Ace Your Exams

A 43-year-old woman presents to the emergency department due to shortness of breath. Four days ago the patient developed fever, myalgias, headache, cough, and shortness of breath. The myalgias and headache have subsided, but the cough and shortness of breath have continued to worsen. The patient has no past medical history and takes no medications. The patient lives with her husband and a healthy baby that she gave birth to eight weeks ago. Temperature is 38.5 ºC (101.3 ºF), pulse is 96/min, respirations are 18/min and blood pressure is 118/77 mmHg, and oxygen saturation is 94% on room air. On physical examination, the patient appears uncomfortable but is not using accessory muscles to breathe. There are faint wheezes and rhonchi throughout both lung fields. Nasal swab specimen is pending. Which of the following is a high-risk feature that indicates the need for empiric treatment with a neuraminidase inhibitor despite her presentation > 48 hours after symptoms onset?