Cavitating lung lesion and hemoptysis in a young woman

Abstract

In February 1996, an 18-year-old girl was admitted to hospital with hemoptysis and a local lesion in the right lower lobe. She was asymptomatic until December 1995, when she developed an unproductive cough. She had dental caries, and 1 month later presented periodontitis and was treated with antibiotics. On admission, she was apyrexial, and chest radiography showed cavitationwithin the right lower lobe. Zhiel^Neelsen staining was negative in several sputum smears, and oropharyngeal contamination was observed on sputum Gram stain. Tuberculin test was negative. A diagnosis of lung abscess was made, and she initially received amoxycillin^clavulanate. Hemoptysis disappeared, lung cavitation reduced and she was discharged. Three months later the pulmonary lesion remained, although the patient was asymptomatic. In June 1996, hemoptysis reappeared and the chest radiography worsened. Bronchoscopic examination showed no endobronchial lesions, and the Zhiel^Neelsen staining and the Lo« wenstein culture of the bronchoalveolar lavage (BAL) were negative. Furthermore, BAL contained no malignant cells. Computed tomographywas performed and is shown above.