Photo Quiz: Female with Long-Standing Cough

Abstract

A 32-year-old female of Thai origin reported to the pulmonology outpatient department with a history of productive cough, sporadic hemoptysis, malaise, and nighttime fever and a 12-week duration of weight loss. She was a lifetime nonsmoker. Physical examination revealed no significant abnormalities, and normal breath sounds were noted during auscultation. Blood analysis showed a hemoglobin concentration of 7.1 mmol/liter, a white blood cell count of 15.1 × 109 cells/liter, and a C-reactive protein concentration of 29 mg/liter. The patient was seronegative for HIV. A sputum sample was submitted to the microbiology laboratory for microscopy and bacterial and mycobacterial cultures. The Gram stain revealed a large number of leukocytes but no bacteria; several slender linear unstained structures were observed (Fig. 1). Fig 1 Gram stain of expectorated sputum sample. Arrows mark two of the slender, linear unstained structures. (For answer and discussion, see page 1353 in this issue [doi:10.1128/JCM.01201-12].)