Azizi Jalilian، Farid نويسنده Dept. of Medical Microbiology, Ilam University of Medical Sciences, Ilam, Iran , , Alavi Darazam ، Ilad نويسنده Mycobacteriology Research Center, NRITLD, Shahid Beheshti University M.C., TEHRAN- IRAN. , , Najafizadeh، Katayoon نويسنده , , Dorudinia، Atosa نويسنده , , Heshmatnia، Jalal نويسنده Department of Internal Medicine, Division of Infectious Disease and Clinical Immunology, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University , , Poursamimi، Parisa نويسنده Department of Internal Medicine, Division of Infectious Disease and Clinical Immunology, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University , , Tabarsi، Payam نويسنده , , Mansouri، Seyed-Davood نويسنده ,
WHAT IS YOUR DIAGNOSIS?
A 60-year-old woman was admitted due to persistent right-sided vague chest
pain since two months ago. She also complained of 5 kg weight loss and
On admission, she was stable and afebrile with mild crackles in both lungs
without tachypnea or remarkable respiratory distress.
She lived in a rural region in southwest of Iran and was being treated with
combined fluticasone-salmeterol and ipratropium bromide due to chronic
bronchitis since five years ago. Exposure to biomass fuels used for cooking and
heating was a possible etiology for her chronic respiratory symptoms. She
denied using systemic corticosteroids in recent months.
Laboratory analysis revealed normal complete blood count, arterial blood gases,
liver and renal function tests, serum lactate dehydrogenase and angiotensin
converting enzyme levels. Human immunodeficiency virus antibody was
negative and plasma immunoglobulin revealed no abnormality.
Chest roentgenographic studies (Figure 1) revealed multiple nodules in both
Based on chest computed tomography (CT) findings and negative repeated
sputum smears, the patient underwent CT-guided biopsy of lung nodules.
Histopathological examination was unremarkable and the procedure was
complicated by pneumothorax.
Finally, bronchoscopy and bronchoalveolar lavage were performed. No
abnormality was detected in the airways.