Differentiating pulmonary cavities

Abstract

To the Editor: We present the case of a patient with pulmonary cavitation of extremely unusual aetiology, which presented a significant diagnostic challenge despite multidisciplinary involvement. A 54-year-old male presented with a 6-week history of haemoptysis associated with fatigue, night sweats and dyspnoea. His past medical history was significant for coronary artery stenting (treated with aspirin). There was no history of exposure to tuberculosis. He had a 50-pack-year smoking history, prior excessive alcohol consumption and had worked in construction, though denied asbestos exposure. On physical examination, vital signs were normal, his dentition was poor, there was no digital clubbing and chest auscultation was unremarkable. Initial chest radiography showed a right upper lobe (RUL) cavity. Laboratory testing confirmed a normal full blood count, and renal, bone and coagulation profiles. An anti-neutrophil cytoplasmic antibody (ANCA) test was negative. Levels of γ-glutamyltransferase (91 IU·L−1, normal range 11–67 IU·L−1), C-reactive protein (215 mg·L−1, normal range <7 mg·L−1) and lactate dehydrogenase (334 IU·L−1, normal range 120–220 IU·L−1) were elevated. Candida albicans was cultured from sputum; blood cultures were sterile and urinalysis was normal. Thoracic computed tomography (CT) demonstrated a 7×5×5-cm RUL thick-walled cavity abutting the pleura with adjacent nodular lesions (fig. …