In this case, an extensive evaluation of a patient with chest symptoms identified an unusual etiology amenable to a simple treatment.
A 40-year-old man presented to our clinic in Bengaluru, India, because of 15 days of fever, breathlessness, and worsening productive cough. He had been treated for repeated episodes of productive cough with intermittent nebulization and expectorants since childhood. Over the 5 years prior to presentation, the cough had become persistent, with expectoration of about 50 mL of mucopurulent sputum per day. Worsening breathlessness during level walking had developed over the past 2 years.
The patient also had experienced brief, repeated episodes of diarrhea and colicky abdominal pain since early childhood. These resolved spontaneously and were never associated with fever, blood in stools, or symptoms suggestive of malabsorption. He denied any history of treated tuberculosis, rhinosinusitis, pneumonia, or exanthematous childhood fevers. He had received the bacille Calmette-Guérin tuberculosis vaccine. There was no significant illness in his family, but he was shorter than his siblings. He did not smoke, abuse alcohol or laxatives, or have unprotected sexual intercourse. He was unmarried and a carpenter by occupation. He did not have any pets, and had not noticed any association between his cough and his work.
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— Srinivas Rajagopala, MD, DM, Uma Devaraj, DNB, Smrita Swamy, MD, Pritilatha Rout, MD
This article originally appeared in the July 2012 issue of the The American Journal of Medicine.
