Chest
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Case Reports
A Previously Healthy 37-Year-Old Man With Acute Hypoxic Respiratory Failure and Fevers.
A previously healthy 37-year-old man initially presented to a hospital near his home with persistent cough after failing outpatient azithromycin for empiric treatment of pneumonia. He was newly employed as a bulldozer operator burying trash in a landfill in Virginia, which he continued throughout his illness. He owned two healthy dogs, had never traveled outside the state, and denied a history of cigarette smoking, alcohol, and substance use. ⋯ Infectious and autoimmune work up that was negative included blood, urine, and BAL cultures, BAL Pneumocystis pneumonia direct immunofluorescence assay, urine legionella antigen, serum HIV antibody, antinuclear antibodies, anti-neutrophil cytoplasmic antibodies, and angiotensin converting enzyme. After improvement in hypoxia with inpatient corticosteroid therapy, he was discharged home with a two week course of prednisone for a presumptive diagnosis of acute eosinophilic pneumonia. He subsequently experienced worsening fever and difficulty breathing; six weeks after his symptoms began, he was admitted to our hospital.
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Case Reports
A 52-Year-Old Man With an 11-Month History of Fever, Cough, Chest Pain, Pleural Effusion, and Left Lung Atelectasis.
A 52-year-old man was referred to our hospital for cough, fever, chest pain, and progressive dyspnea. He has worked as a full-time security staff at a community center and was in a normal state of health until 11 months prior to referral when he began experiencing cough, expectoration, a high-grade fever (up to 39.7°C), chills, and left chest pain. He visited the local hospital several times with suspected lung cancer. ⋯ He was given a course of antibiotics, but his fever had not subsided. The patient had visited a bamboo rat farm and consumed bamboo rat meat one year previously. He had never smoked.
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A 47-year-old woman visited her primary physician for a health check, and some radiographic abnormalities were detected. She was referred to our division for further management. In recent years, she had become conscious of occasional facial hemispasms. ⋯ No signs of RA progression were evident, and the only used antirheumatic drug was bucillamine. The patient had no history of use of immune-modulating drugs or immunosuppressants. No previous chest radiographs or CT had been performed.