A 46-year-old woman who was a nonsmoker presented to the respiratory clinic with productive cough and exertional dyspnea. She had previously received a single renal transplantation 10 years before for treatment of IgA nephropathy, and was maintained on a regimen azathioprine, cyclosporin, and prednisolone. She did not complain of hemoptysis, fever, or weight loss, and there was no history of asthma or heart disease.
On examination, the patient was afebrile and not in respiratory distress. There was no clubbing or cervical lymphadenopathy, and auscultation of her chest revealed diffuse biphasic wheeze. Other than a scar in the right iliac fossa where the kidney had been transplanted, the rest of her clinical examination was unremarkable.