Ten weeks after the hospital admission of Case 1, a 76-year-old
man was admitted to the hospital for progressive dyspnea, pleuritic
pain, and malaise of 1-month duration. Cough, fever, and increased
sweating were denied. Medical history consisted of peptic disease,
diaphragmatic hernia, heavy smoking, and stable ischemic heart disease.
On hospital admission, the patient was cachectic, with no fever,
pallor, or cyanosis. Respiratory rate was 30 breaths/min, BP was 150/65
mm Hg, and the pulse rate was 88 beats/min. Rales were heard in the
right apical region of the lungs, the examination findings being
otherwise unremarkable. The ESR was 70 mm/h, a leukocyte count showed
13,200 cells/μL, and the serum albumin level was 3.0 g/dL. Findings
of all other routine laboratory tests were normal.