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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 47-Year-Old Man With Cough, Dyspnea, and an Abnormal Chest Radiograph

Jaime Palomino, MD; Omar Saeed, MD; Philip Daroca, MD; Joseph Lasky, MD, FCCP
Author and Funding Information

*From the Department of Pulmonary, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA.

Correspondence to: Jaime Palomino, MD, Tulane University Health Sciences Center, Pulmonary, Critical Care, and Environmental Medicine, 1430 Tulane Ave, SL-9, New Orleans, LA 70112; e-mail: jpalomin@tulane.edu


Dr. Lasky has reported conflicts of interest pertaining to honoraria for lectures, compensation for the enrollment of patients in clinical studies, and service on data safety monitoring boards. Drs. Palomino, Saeed, and Daroca have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):872-875. doi:10.1378/chest.08-1721
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A 47-year-old man was referred to a pulmonary clinic with a 4-year history of dyspnea, productive cough, weight loss, low-grade fevers, night sweats, and occasional hemoptysis. During those 4 years, the patient had undergone multiple serologic, sputum microbiological, and radiographic studies, as well as a bronchoscopy examination; 4 months prior to referral, due to worsening in symptoms, video-assisted thoracoscopic surgery (VATS) for right lung biopsy was performed. Due to the patient's clinical symptoms and abnormal radiographic findings, he had received multiple courses of antibiotics, including 2 months of RIPE therapy (ie, therapy with isoniazid, rifampin, ethambutol, and pyrazinamide) for undocumented tuberculosis, without any significant response. His medical history was positive for COPD, chronic sinusitis, recurrent pneumonias, gastroesophageal reflux disease, hepatitis C, and alcohol abuse. He did not have any history of uveitis, cervical/lumbosacral stiffness, or musculoskeletal pain. His family history was not contributory. His surgical history was remarkable for a VATS procedure for right lung biopsy. His medication list included formoterol, albuterol, pantoprazole, diazepam, and tiotropium. He smoked two packs of cigarettes a day for 30 years. The patient was from rural Mississippi, and he reported no history of travel outside of this area. He was a farmer but had been unable to work during the last 2 years due to his poor health status.

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