Another Weird Health Story...

  1. Pt goes to PCPdoc for antibiotics for what appears to be a URI. Doc prescribes antibiotics and, noting that pt is sob and wheezing, also orders a CXR and bronchodilators. Pt sputum sample is negative, but CXR is positive for bronchial pneumonia and nodules. Followup CXR repeats nodule dx.
    Pt is then sent for CT scan. Pt shows no real improvement after course of antibiotics, but the bronchodilators do help. CT scan shows cavitating nodules, suggests dx as fungal infection, septic PE, TB, or CA. Pt is neg for TB and septic PE. (No blood work was done prior to CT scan.)
    About a month drags by while all this is going on.
    One night, Pt has episode of respiratory distress lasting several hours, but pt does not go to ER and therefore cannot prove respiratory distress; c/o awakening "gasping for air for about 4 hours, feeling dry, and after several quarts of fluids, finally began crying in frustration and fear, then finally coughed, relieving the symptoms almost immediately." Pt goes to PCP for f/u one week later. PCP explains episode as "mucous plug." PCP orders pulmo consult.
    Pulmo guy admits he doesn't know what x-rays or CT scan means, but neither X-rays look like typical pneumonia to him. Because there is no baseline and because pt "doesn't appear to be acutely ill--no loss of appetite, no real c/o except SOB-- but X-rays are definitely abnormal," Pulmodoc doesn't think it's fungal infection or Ca. Pulmodoc actually suggests that pt could've had nodules for a long time, and pneumonia was coincidental. Pt then pointed out that there had been no real improvement with the pneumonia-like symptoms. Pulmodoc said lungs were clear. Pt pointed out that lungs might be clear because pt was taking bronchodilators??!
    Pulmo guy sets up appt for PET scan, explaining that it's less invasive than wedge resect , and does some blood tests.

    Anyone have any ideas what could be going on here????
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    Joined: Dec '01; Posts: 3,165; Likes: 59


  3. by   CATHYW
    My guess is fungal, asbestosis, or inhalation exposure. How old is this person, what is their occupation, what kind of work have they done in the past, what are their hobbies, where do they live?

    BTW, what ever happened to bronchs? You can visualize, bx, pathologize (LOL!), and have a definitive dx.
  4. by   Furball
    Sarcoidosis? Just a shot in the dark. If he's taking steroid inhalers...that would help....I dunno...weird
  5. by   Sleepyeyes
    I'll certainly keep you updated when I find out more. Thanks for the suggestions...
  6. by   adrienurse
    My grandfather, a retired farmer, was hospitalized last year for what turned out to be mould infecting all the wheat fibres he had inhaled in his life that had remained in his lungs.
  7. by   Furball
    Wow,,,that sounds he ok now?
  8. by   adrienurse
    You talkin' to me? Yeah, he's doing a lot better. We thought he was gonna die.
  9. by   Sleepyeyes
    This person used to own horses and did have exposure to hay... but not all their life.
  10. by   CATHYW
    Hmmm-that might be enough. The hay and grass fibers and seeds and the different types of dust associated with them could have been inhaled and retained. Perhaps the body has "walled them off" as in TB, or perhaps they are fungal or bacterial in origin. One would think if it was either of those though, that a fever would be present, as well as some weight loss.
  11. by   oramar
    Funny the Pulmonary guy did not do a bronch. Bronchial washing have diagnosed a lot of funny looking things.