76 y/f smoker and COPD. Comes to the ER with a history of cough and hialin spit, very transparent, almost saliva for the last 6 months associated only to weight loss. She denies fever or any other symptom. BP normal, CF normal, oxygen 89% without supplementation, RF 22x'. Leucogram initially elevated leucocytes and left deviation but has improved to normal without antibiotics. No anemia. Tuberculosis (-), HIV (-), CMV (-), EBV (-), spit cultures negative. p-ANCA (+), c-ANCA (+).
Radiography an TC show a very dense infiltrate base predominance and several nodes apical and basal. Heart's anatomy and function preserved. Bronchoscopy (+) Corynebacterium pseudodiphtheriticum and Streeptococcus viridans. Today, after 20 days of hospitalization, the patient has not shown any improvement. No antibiotics therapy has been administered. Biopsy says: "Negative for malignancy". Radiologists, pathologists, infectologists, reumatologists and neumologists donÃƒÂ½ know the diagnosis... HELP PLEASE!
Tuesday, 02 February 2010
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