SESSION TITLE: Chest Infections I
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM
INTRODUCTION: In this article, we report a case, presenting with pulmonary nodule under immunosuppressive medication who was diagnosed by VATS
CASE PRESENTATION: A 50-year-old, previously healthy woman was presented with a 8-day history of fever (38°C to 40°C), non-productive cough, arthralgias. She had a past history of surgery for hydatid cyst (liver) 4 years ago and one year of prednisone use (initial dose: 20 mg/day, maintenance dose: 5 mg/day) for rheumatoid arthritis. On physical examination, she was febrile (38.7°C), tachycardic, with a heart rate of 108/min and her respiratory rate was 22 breaths per minute. Bilateral ronchi during expirium were present on chest auscultation. No pathological laboratory findings except leucocytosis and the elevated C-reactive protein level of 58 mg/dl were found. Serum serology for human immunodeficiency virus was negative. Both sputum cultures and aerobic blood cultures revealed negative results. Ziehl-neelsen staining of sputum was negative for acid fast bacilli. Chest computed tomography showed nodular formations surrounded by ground-glass opacities in the right anterior upper lobe, right middle lobe and right inferior posterobasal lobe. Ampicillin/sulbactam 4x1.5 gr/day, chlarytromycin 2x500 mg/day were started for the non-specific treatment of nodular formations. Hence chest radio-graphic findings of the patient did not regress and the diagnosis could not be made from culture results, diagnostic VATS was performed in the differential diagnosis of sarcoidosis, tuberculosis, rheumatoid nodule, cyst hydatid. The histopathological examination revealed polymorphonuclear leukocytes in the granulomes, indicating granulomatous disease, existing tuberculosis and sarcoidosis and suggesting cat scratch disease. After the patient was questioned again regarding her medical history, we found that 17 cats lived in her house and she was occasionally clawed by them. The patient received doxycycline 200 mg/day for 4 weeks after VATS according to the histopathological findings. After the treatment, the patient was discharged from the hospital without any complication.