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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 56-Year-Old Man With Choking, Recurrent Pneumonia, and Weight Loss*

Michael Eberlein, MD, PhD; David B. Pearse, MD
Author and Funding Information

*From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.

Correspondence to: David B. Pearse, MD, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Bayview Medical Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224; e-mail: dpearse@jhmi.edu



Chest. 2007;131(4):1248-1251. doi:10.1378/chest.06-1066
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A 56-year-old man presented to the pulmonary clinic for evaluation of recurrent pneumonia. He was well until 3 years before this clinic visit, when productive cough for > 2 weeks developed, followed by chills, fever of 39.4°C, and a left lower lobe infiltrate on chest radiography. Antibiotic treatment resulted in complete resolution of symptoms and radiographic findings. One year later, he presented with similar symptoms and a right lower lobe infiltrate. He was admitted to the hospital, sputum cultures were unrevealing, and he recovered after a course of broad-spectrum antibiotics. Four months before presenting to clinic, he choked during a meal and had a persistent productive cough that failed to respond to two separate courses of oral antibiotics. Fever and chills developed, and he was hospitalized for pneumonia. A chest CT scan showed alveolar infiltrates in bilateral lower lobes. His fever resolved with antibiotic treatment, but the productive cough continued. His medical history was unremarkable, and he was a lifelong nonsmoker and took no medications or illicit drugs. He specifically denied consuming mineral oil or using oily nose drops. Review of systems revealed an unintentional 20-lb weight loss over the past 2 years accompanied by frequent loose bowel movements, morning shoulder stiffness, occasional insomnia, and palpitations. He also described a presyncopal episode that occurred following the first pneumonia episode. Emergency department evaluation at that time revealed sinus tachycardia with 2 s of wide-complex tachycardia. Myocardial infarction was excluded, and the echocardiogram and stress and tilt table testing results were unremarkable. He denied loss of consciousness.

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