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.