40-year-old woman with infiltrates and pulmonary eosinophilia
PG Noone, MD FCCP. A 40 year old woman with malaise, night sweats, and pulmonary infiltrates. She had had two separate courses of antibiotics (azithromycin and levofloxacin) with no benefit. She had malaise, occasional sweats, a non-productive cough, and nasal obstruction. There was also a central soreness across her chest. Past history included upper airway allergy symptoms requiring occasional courses of anti-histamines, and an intermittent cough but no clear-cut history consistent with asthma. She also had depression requiring fluoxetine (prozac). Physical examination was normal apart from slight pallor. There were no crackles or wheezes. There was no hepatomegaly. Laboratory investigations showed a slight anemia (Hgb 10g/dl), an elevated ESR (118 mm/min), a white cell count of 10,000/L , with an absolute eosinophil count of 0.9 x 109/L. P-ANCA and ANA were weakly positive, C-ANCA, and RF were negative. Serum IgE was normal. Urinalysis was clear. Radiographs are as shown. Dense infiltrates are visible both on the plain radiograph (postero-anterior view, and lateral view), primarily posteriorly in the upper lobes, which is confirmed on the CT scan as shown. | |
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