DISPATCH reported that all their patients had radiologic evidence of consolidation at admission (9). In another study of 10 cases, 9 had abnormal chest x-ray results (3). A Canadian study reported that two of nine patients had subtle chest radiographs. Repeat chest x-rays were read as normal in these two patients (2). Without radiographic abnormalities, CLINICAL STUDIES Figure 2. Radiograph on day 11 of hospital stay (day 14 after con- tact with a SARS patient). the diagnosis of SARS can be difficult, especially if a cause for fever exists. By the time the radiographs became abnormal in our patient, he had infected healthcare work- ers. The implications of such a case and its consequences on the practice of medicine are important, even in current SARS-free areas because of world travel. Although we are taught to apply Occam’s razor and search for a unifying diagnosis, multiple coexisting condi- tions are a part of clinical medicine. SARS can coexist with other febrile illnesses. The combination of atypical signs and symptoms and a coexisting diagnosis can have negative public health implications. Close contact is defined by WHO as having cared for or lived with a SARS patient or having had direct contact with respiratory secretions and body fluids of a SARS patient. This contact history is often difficult to determine and quantify. In one case, the only “contact” elucidated was passing through an emergency department of a hospi- tal with a SARS outbreak (10). We are not the first group to have seen atypical SARS in a patient with multiple coexisting conditions (10). In a SARS outbreak, we suggest that all patients with undifferentiated fever or pneumonia be cared for as if they had SARS for the safety of healthcare workers and patients, implying the use of full precautions (N95 respira- tors, gown, gloves, and goggles) by healthcare workers for all patient-care activities (e.g., ward rounds, baths, wound dressings, performance of radiologic procedures). A pow- ered air purifying respirator should be used when perform- ing aerosol-generating activities, e.g., chest physiotherapy. Patients with undifferentiated fever or pneumonia should be placed in single rooms that meet generally accepted guidelines for the isolation of infected persons (11). Establishing an explanation for the fever (e.g., a positive blood culture) in a person with a contact history should not Figure 1. A, radiograph on admission; B, radiograph on day 5 of hospital stay; C, radiograph on day 7 of hospital stay. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 2, February 2004 351