Search for the Complication

A CLINICAL PROBLEM-SOLVING article by Francis Salamon from Rabin Medical Center in Israel and colleagues. A 58-year-old woman was hospitalized for evaluation of prolonged fever and hemoptysis. She reported having had intermittent fevers, a productive cough, shortness of breath, and hemoptysis during the previous eight months. CT of the chest revealed peripheral infiltrates in the upper lobe of the left lung and lingula and a calcified left hilar opacity, with additional, small mediastinal lymph nodes. Bronchoscopy demonstrated hyperemic bronchi. Culture of a bronchial-lavage specimen was positive for a nontuberculous, slow-growing mycobacterium. Staining and culturing were negative for M. tuberculosis. A tuberculin skin test was positive. The patient had a history of hypertension, chronic atrial fibrillation, inflammatory bowel disease, and hypothyroidism that was attributed to the use of amiodarone. She had undergone catheter ablation procedure one year earlier, after which the amiodarone had been stopped. The laboratory finding and the results of CT angiogram and ventilation–perfusion lung scans are discussed. A diagnosis made after much testing sometimes raises the question of why the correct diagnosis was not made earlier. In some cases, diseases are overlooked because they are rare, mimic other diseases, or present atypically. The diagnosis of a relatively new clinical syndrome is especially challenging. This case concerns such a challenge. (211 words)