ATS 2004: Clinical Radiologic Pathological CorrelationsCase 1037 year old with cavitary pulmonary nodule
This 37 year old Philippine woman presents with night sweats,
fever, fatigue and occasional wheeze. She has had a 25 Kg weight
loss over the last year while these symptoms have developed. Her
past history is significant for living near a chicken coop and
developing histoplasmosis 15 years previously. She also had a
positive PPD 10 years ago and was treated for 9-12 months with
INH/Rifampin (changed to Ethambutol/Rifampin due to INH allergy).
She was also diagnosed 19 years ago with “iritisâ€. She does not
smoke. Her initial evaluation includes a chest radiograph and chest
CT scan (Figure 10.1). A transbronchial biopsy was obtained and was
negative for mycobacteria or fungus. Athoracoscopic resection of
the lung lesion was performed (Figure 10.2). She was treated with
clarithromycin and cefixime because her pertussis titers were
elevated.
Question 10
|
Subsequently the patient returns with recurrence of fever, night
sweats, cough, fatigue, and a macular rash on her face and anterior
chest. A repeat chest CT is obtained (Figure 10.3). Your leading
diagnosis is:
|
| a. |
Necrotizing sarcoid granulomatosis |
| b. |
Mycobacterium tuberculosis infection |
| c. |
Histoplasmosis infection |
| d. |
Wegener’s granulomatoisis |
| e. |
Pertussis infection |
|
Answer to Question 10Answer is a.
Diagnosis: Necrotizing sarcoid granulomatosis | 
