Case report
A 65-year-old male was admitted to Afzalipour hospital in Kerman, complaining of fever, worsening dyspnea, pleuritic chest pain and hemoptysis. He also mentioned weight loss, night sweats and fatigue. The patient had been well until 3 months before admission to this hospital, when hemoptysis and fatigue developed. After 6 weeks, the patient experienced night sweats and fevers with temperatures of up to 38.4 °C.
The patient’s past medical history revealed a diagnosis of chronic bronchitis, for which he was prescribed a metered dose inhaler containing fluticasone and salmeterol. In his habitual history, the patient disclosed a history of cigarette smoking, amounting to 15 pack-years. No history of opium consumption or other substance use was reported.
On examination, he was ill but not toxic, the heart rate was 108 beats per minute, the blood pressure 128/76 mmHg, the respiratory rate of 31 breaths per minute and the corrected axillary temperature of 38.6 °C. His oxygen saturation was 95% while the patient was breathing ambient air. The weight was 67.4 kg and the body-mass index (the weight in kilograms divided by the square of the height in meters) was 21.2.
On the head examination, temporal wasting and signs of cachexia were observed. Oropharyngeal examination revealed no evidence of bleeding, ulceration, scar tissue, or tumor. There were no signs of lymphadenopathy, masses, or crepitation on neck examination. Respiratory examination indicated increased respiratory effort with mild accessory muscle use. No chest deformities or asymmetry were noted, though mild tenderness was observed over the chest wall. The breath sounds were decreased with crackles heard predominantly over the left lung base. Regular rate and rhythm with no murmurs appreciated on heart examination. S1 and S2 sounds clear. Other systemic examinations were found to be normal.
Nucleic acid testing of a nasopharyngeal swab was negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acid-fast bacilli smear and culture of the sputum was negative for mycobacteria. Other laboratory test results are summarized in Table 1.
Table 1. A Summary of Laboratory Test Results.