A 70-Year-Old Man With Pulmonary Infiltrates and a Positive Antineutrophil Cytoplasmic Autoantibody Test Result

Abstract

(CHEST 2005; 127:1045–1050) A 70-year-old white man was referred for evaluation of pulmonary infiltrates and bronchiectases associated with cough and constitutional symptoms. He was in his usual state of health until he acquired B-cell non-Hodgkin lymphoma (NHL) in 1990. The lymphoma was localized to his stomach, and he was treated with surgical resection; chemotherapy with cyclophosphamide, vincristine, prednisone, and hydroxyurea; and radiation to the gastric bed. One year later, left lower lobe pneumonia developed that was treated with antibiotics. Because of persistent infiltrates, bronchoscopy was performed, with biopsy specimens revealing no abnormalities, and bronchiectases was diagnosed based on radiographic features. Three years prior to presentation, a cough productive of green-to-yellow sputum without hemoptysis developed. One year prior to presentation, progressive fatigue, anorexia, low-grade fevers, significant night sweats, and subsequent 20-lb weight loss developed. He denied other respiratory complaints. CT of the chest revealed patchy areas of consolidation in both lower lungs and in the right middle lobe along with mild mediastinal lymph node enlargement. Multiple sputum samples for acid-fast bacilli, bacteria, and fungi were negative. Endoscopic evaluations of his upper and lower intestinal tracts did not reveal recurrence of the lymphoma. Established medical problems included hypothyroidism and a previous myocardial infarction with subsequent revascularization surgery. He never smoked, and his family, social, and exposure history were otherwise noncontributory. He was referred to our tertiary care center for evaluation of productive cough, pulmonary infiltrates, worsening fatigue, persistent low-grade fevers with night sweats, and weight loss.