A rare pulmonary pathology complicated with an unusual condition. Issue 2 (June 2019)

• Record Type: Journal Article
• Authors: Kotoulas, Serafeim Chrysovalantis; Manika, Katerina; Pilianidis, Georgios; Tsikouriadis, Paulos; Kalopitas, Georgios; Petridis, Nikolaos; Apsemidou, Athanasia; Iakovos, Avramidis; Kioumis, Ioannis
• Is Part Of: Breathe. Volume 15:Issue 2(2019)
• Page Start: 121
• Page End: 127
• Publication Date: 2019-06
• Subjects: Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Periodicals; 616.2005
• DOI: 10.1183/20734735.0117-2019
• Languages: English
• ISSNs: 1810-6838

Abstract

A 73-year-old male presented to the emergency department complaining about fatigue, night sweats, lack of appetite and weight loss for the past 2 months. His baseline weight was 47 kg and his height was 1.78 m (body mass index of 14.83 kg·m −2 ), while at presentation he weighed 39 kg. From his history, he underwent gastrectomy 31 years ago for stomach cancer. He was a smoker (55 pack-years), with no history of alcohol consumption or any other known pathological condition. Despite his gastrectomy, he did not suffer from symptoms suggesting reflux disease. 2 years ago, his daughter suffered from pulmonary tuberculosis, but he was not checked at that time with either a Mantoux test or chest radiograph. Physical examination revealed crackles in both lungs. His heart rate and blood pressure were normal. Because of his gastrectomy, he was on treatment with B12 and folic acid supplements and on presentation he did not reveal megaloblastic anaemia. From his laboratory examinations, his white blood cells were normal (9780 cells·μL −1 (68.4% neutrophils, 21.7% lymphocytes)) while his C-reactive protein was elevated (8.87 mg·dL −1 ). Despite his obviously impaired nutritional status his serum albumin was slightly above the lower normal level (3.67 g·dL −1 ). His chest computed tomography (CT) revealed infiltrations bilaterally, signs of incipient pulmonary fibrosis with thickened interlobular septa, centrilobular nodules and loss of volume of the left lower lobe (figure 1). His blood gas analysis revealed hypoxaemia; therefore, he was admitted to hospital and initiated intravenous antibiotic treatment with ampicillin/sulbactam plus azithromycin. Differential diagnosis should never be limited to the obvious diagnoses http://ow.ly/ybTM30obh6H