An unusual case of pneumonia

Abstract

A 41-year-old European man presented with a 4-week history of increasing dyspnoea, left pleuritic chest pain, productive cough and 7 kg weight loss. He had smoked 60–70 cigarettes per day for many years, and he drank 3 pints of beer daily. He had had a myocardial infarction 5 years before, and had paranoid schizophrenia, well controlled on monthly flupenthixol injections. On examination, he was pyrexial with signs of consolidation at the left lung base. There was no adenopathy. His fingers were heavily nicotine stained and his dental hygiene very poor. Investigations revealed a mild anaemia, elevated white blood cell count and ESR 100 mm/h.