• Diego Bueno-Sacristán, Beatriz Pintado, Diego Durán-Barata, Antonia Navarro-Cantero, Rosa Mariela Mirambeaux, José Palacios, Deisy Barrios, and Amparo Benito.
• Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
• Chest. 2022 Feb 1; 161 (2): e97-e101.

Case PresentationAn 84-year-old man with an active smoking habit presented to the ED with dyspnea, hemoptysis, and thick phlegm that was difficult to clear. He reported no weight loss, no fever, and no chest pain or dysphonia. He denied both international travel and previous contact with confirmed cases of TB or SARS-CoV-2. He had no known occupational exposures. The patient's personal history included a resolved complete atrioventricular block that required a permanent pacemaker, moderate-to-severe COPD, rheumatoid arthritis (treated with oral prednisone, 2.5 mg/d) and B-chronic lymphocytic leukemia (treated with methotrexate and prophylactic oral supplements of ferrous sulfate). Moreover, he was in medical follow up because of a peptic ulcer, atrophic gastritis, and colonic diverticulosis. The patient also had a history of thoracic surgery after an episode of acute mediastinitis from an odontogenic infection, which required ICU management and temporal tracheostomy.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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