• Ilias E Dimeas, Sotirios I Sinis, Ioanna K Sgantzou, Maria Ioannou, Konstantinos I Gourgoulianis, and Zoe Daniil.
• Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece. Electronic address: dimel13@hotmail.com.
• Chest. 2020 Jul 1; 158 (1): e25-e31.

Case PresentationA 71-year-old ex-bus driver (ex-smoker, 20 pack-years) was admitted for the first time to the respiratory department because of chronic dry cough and progressive exertional dyspnea with insidious onset 8 years ago. The patient also reported weight loss of about 20 kg in 3 years and proximal muscle weakness. A decade ago, he was diagnosed with gastric adenocarcinoma and subjected to partial gastrectomy and splenectomy, followed by an unspecified chemotherapy regimen. Additionally, the patient has coronary disease and underwent coronary bypass graft surgery 7 years ago. In the course of his disease, many diagnostic procedures have been performed including Mantoux tests, five CT scans, a CT-guided biopsy, two bronchoscopies, and an 18F-fluorodeoxyglucose PET scan with inconclusive results. The patient was referred to the hospital to have his long-lasting condition diagnosed and treated.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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