A 55-Year-Old Smoker With a Persistent Right Lower Lobe Infiltrate

Abstract

(CHEST 2005; 127:2266–2270) A 55-year-old African-American man presented with a week-long history of cough with bloodstreaked sputum. He denied fevers, night sweats, weight change, and sinus symptoms. He was physically active and had no dyspnea on exertion. He reported gastroesophageal reflux symptoms but denied any other complaints. His medical history included diverticulosis and depression. He took no medications. He was an active smoker with a 60pack-year smoking history. In addition, he smoked crack cocaine with reported use 3 months prior. He denied alcohol or IV drug use. He had no significant travel, occupational, or exposure history. His physical examination was unremarkable. A chest radiograph revealed an ill-defined infiltrate in the right lower lobe (Fig 1). Laboratory study findings, including cell counts and blood chemistry measurements, were normal. The results of HIV and hepatitis serology tests were negative. A presumed diagnosis of community-acquired pneumonia was made, and the patient was treated with an oral fluoroquinolone for 10 days.