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Pulmonary and Critical Care Pearls |

A 35-Year-Old Man With Persistent Cough, Fever, and Sore Throat*

Marc Noppen, MD, PhD, FCCP; Katrien Bervoets, MD; Brigitte Velkeniers, MD, PhD; Anita Goossens, MD; Jan Lamote, MD; Walter Vincken, MD, PhD, FCCP
Author and Funding Information

*From the Respiratory Division (Drs. Noppen, Bervoets, and Vincken), Department of Internal Medicine (Dr. Velkeniers), Department of Pathology (Dr. Goossens), and Thoracic Surgery Department (Dr. Lamote), Academic Hospital AZ-VUB, Brussels, Belgium.

Correspondence to: M. Noppen, MD, PhD, FCCP, Respiratory Division, Academic Hospital AZ-VUB, Laarbeeklaan 101, B-1090 Brussels, Belgium; e-mail: pnennm@az.vub.ac.be



Chest. 1999;116(1):248-251. doi:10.1378/chest.116.1.248
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A 35-year-old white Belgian man with an uneventful medical history was referred from Port Said, Egypt, for fever of unknown origin. As a civil engineer, he was working on a tunnel project with 50% of his day spent underground in caissons. About 6 months before referral, he developed a sore throat, hoarseness, nasal congestion, cough, and slightly enlarged submandibular glands, with a temperature up to 39.5°C. Within a few days, slight-to-moderate sternal and anterior chest pains were noted. An initial clinical evaluation included a chest radiograph and CT scan that were interpreted as normal. His erythrocyte sedimentation rate was >100 mm/h. A hemogram was normal except for thrombocytosis and a mild normochromic normocytic anemia. A serologic test for Epstein-Barr virus and blood polymerase chain reaction assay for Mycobacterium tuberculosis were positive. HIV serology was negative. Empiric treatment with cefuroxime acetyl and roxithromycin was unsuccessful. After 6 months of persistent symptoms and a 10-kg weight loss, he was referred for evaluation.

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