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A 48-Year-Old Smoker With Cough and Weight Loss*

Benjamin T. Suratt, MD; Carolyn H. Welsh, MD, FCCP
Author and Funding Information

*From the Denver Veterans Affairs Medical Center, Denver, CO.

Correspondence to: Benjamin T. Suratt, MD, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Box C272, 4200 East Ninth Ave, Denver, CO 80231; e-mail: benjamin.suratt@uchsc.edu



Chest. 2000;118(1):239-241. doi:10.1378/chest.118.1.239
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Extract

A48-year-old male smoker was referred for the evaluation of symptoms of cough, weight-loss, and chest radiograph abnormality. The patient had a medical history significant for chronic bronchitis and had been seen by his primary care physician 2 months previously for worsening nonproductive cough without fever or shortness of breath. He was treated with erythromycin after chest radiography demonstrated a right middle-lobe infiltrate, while the results of a sputum culture revealed “normal flora.” The patient’s cough continued over the following month, complicated by gradually worsening dyspnea on exertion and weight loss, and he returned to the clinic. On examination, the patient was afebrile and had normal room air oximetry findings, but had persistent bronchial breath sounds in the right mid-chest. The results of serum chemistry tests and CBC were in the normal range. A repeat chest radiograph and a chest CT scan were performed (Fig 1 ). Fiberoptic bronchoscopy revealed an erythematous, narrowed right middle-lobe orifice with extruding tan purulence. The results of an endobronchial biopsy demonstrated only inflammatory changes, while the results of an acid-fast bacillus stain of endobronchial washings were negative. A Papanicolaou stain of the washings is shown in Figure 2 .

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