A 47-year-old man with chronic renal failure was evaluated for 3 months of nonproductive cough. He also complained of mild breathlessness with exertion, but otherwise felt well. He denied fevers, chills, weight loss, and hemoptysis. He had no symptoms of sinus disease, asthma, or gastroesophageal reflux. A tuberculin skin test was nonreactive.
The patient’s medical history included chronic renal failure caused by hypertension. He had been hemodialysis dependent for 4 years, and had been hospitalized twice for hypervolemia and hyperkalemia. His medications included minoxidil, labetalol, calcium acetate, and vitamins. Prior to the development of renal failure, the patient worked in construction. He denied use of tobacco, alcohol, and illicit drugs, and had no recent travel.