Midwest Midwinter Lung Conference: CPC Session
Case 3
Douglas B. Hornick, M.D. and Carl Lawyer, M.D.
Peer Review Status: Not Peer Reviewed
T.D.
29 y.o. WM with recurrent pulmonary infections.
A 29-year-old man was referred for evaluation of recurrent
pneumonias. This patient's history began approximately five years ago
when he was hospitalized for a right upper lobe pneumonia
(chest x-ray). Subsequent to this
admission he has had recurrent pneumonias two to three times a year.
These episodes have required visits to local emergency rooms and
antibiotics. The most recent occurrence was two weeks prior to being
seen at UIHC. At that time he presented locally with his typical
symptoms of fevers, cough productive of yellow sputum, dyspnea, and
right pleuritic chest pain. The chest
X-ray showed a right upper lobe infiltrate and right hilar
fullness. He was given oral Erythromycin but did not tolerate the
drug, so he was given Cefaclor 250 mg TID for ten days. His symptoms
improved after the course of antibiotics. Over the past several
months he has noticed more generalized fatigue. He has had night
sweats off and on over the past 5 years but denied any exposure to
tuberculosis and has a negative PPD. The patients has no known
underlying lung disease and denies HIV risk factors. He has a ten
pack-year smoking history. He is intermittently employed as a brick
layer. Past medical history is only remarkable for depression. He is
on no medications. His physical exam is most remarkable for
diminished breath sounds in the right upper lobe. The
chest x-ray from his
current visit.
Click on small images below to magnify
Chest x-ray
from first pneumonia episode
Chest x-ray
from last pneumonia episode
Chest x-ray
from the current evaluation
Detail of
current Chest x-ray
What is the most likely diagnosis and what procedure(s) would
help you confirm your suspicion?