Non-smoker with pulmonary nodules

Abstract

A 57-year-old man was admitted to the hospital in May because of fever, night sweats, cough, dyspnea, and multiple pulmonary nodules. He had non-insulin dependent diabetes and had been in his usual state of health until three months before admission, when he was successfully treated with a six-week course of antibiotics for right foot osteomyelitis. One month before admission, he was treated for a dry cough and dyspnea, attributed to worsening congestive heart failure. Five days before admission, he developed fever, night sweats, dry cough, pleuritic chest pain, but no hemoptysis. Over the past six months, he had lost 30 pounds. He was admitted for workup. Antibiotics were not started. The patient was a married, black, retired handyman/ doorman with a past history of diabetic retinopathy, CHF, mitral regurgitation, remote CVA with residual left facial droop. There was no history of recurrent sinusitis. His medications included furosemide, captopril, digoxin, glyburide, lovastatin, ranitidine, and oxycodone. He was born in New York City and had spent most of his life in New York, except 20 years ago, when he lived in Western Texas for three to four months. He had not traveled outside of North America.There was no history of tobacco use, drug use, alcohol abuse, HIV risk factors, asbestos exposure, or undercooked seafood ingestion. He did not have pets or unusual bird exposure. On examination, the temperature was 100.6”F, blood pressure 150/80 mmHg, pulse 92/min, and respiratory rate 20/min. Fundoscopic examination revealed diabetic retinopathy, but no evidence of endophthalmitis. No adenopathy was found. Jugular venous distention was elevated at 10 cm. There were bibasilar crackles and pedal edema. Oxygen saturation was 96% on room air. No clubbing was noted. There were no murmurs, Osler nodes, Janeway lesions, splinter hemorrhages, subconjunctival hemorrhages, or Roth spots. There was