June 2016 pulmonary case of the month

Abstract

No abstract available. Article truncated after first page. History of Present Illness: A 77-year-old gentleman presented with 6 weeks of: sinus congestion; bloody nasal discharge; cough with maroon sputum; dyspnea; hearing loss; painful peripheral neuropathy; left median neuropathy and left foot drop; fevers. Past Medical History, Social History and Family History; no significant past medical history; retired; does not smoke; family history is noncontributory. Physical Examination: temperature of 37.8º C; bloody nasal discharge; lungs clear to auscultation and percussion; heart with a regular rhythm without murmur; neurologic findings consistent with his complaints. Laboratory Evaluation: elevated white blood cell count with a left shift; Na+ 130 mEq/L; 10-20 RBCs on urinalysis. Radiographic Evaluation: Initial chest x-day is shown in Figure 1. Which of the following is (are) the next appropriate steps in the evaluation? 1. Transthoracic echocardiogram; 2. Treat with macrolide antibiotics for outpatient pneumonia; 3. Thoracic CT scan; 4. 1 and 3; 5. All of the above. ...

Keywords

• Wegner's granulomatosis
• granulomatosis with polyangitis
• PGA
• hemoptysis
• renal disease
• vasculitis
• sinusitis
• bronchosocpy
• endobronchial biopsy
• treatment