Abstract
Case History A 56-year-old white man was admitted to his local hospital in Georgia because of vague chest discomfort, cough productive of mucoid expectoration, a ten-pound weight toss, and malaise of two months duration. He denied night sweats, hemoptysis, or exposure to tuberculosis. He had recently taken a trip to Arizona. Physical examination was unremarkable. Hemoglobin was 9.7gm%; hematocrit 32%, total WBC count 6200/cu mm, with 52% neutrophils, 350/o lymphocytes, 50'/o monocytes, and 3% eosinophils. A PPD skin test was negative on two occasions. Chest roentgenograms showed a 3.6 by 2.5cm, thinwalled cavity in the right upper lobe. The patient underwent fiberoptic bronchoscopy. Bronchial brushings and transbronchial biopsies were obtained. Stains for acid-fast bacilli were negative. A KOH preparation of post bronchoscopic sputum revealed no fungi. Cytology was negative. Histological examination of lhe transbronchial biopsy specimens revealed granulomatous inflammation with caseation necrosis. flgure t : PA Chest roentgenogi-am showing right upper lobe caviry.
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