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A 63-year-old man was an ex-smoker with chronic paranasal sinusitis, chronic hepatitis B, benign prostate hyperplasia and newly diagnosed chronic lymphocytic leukaemia. He presented to the respiratory clinic for productive cough and shortness of breath for 6 months. Physical examination revealed bilateral basal crackles without wheezes. CT of the chest showed diffuse centrilobular nodules arranged in a branching linear pattern (tree-in-bud sign) and bronchiectasis (figure 1, arrows). White cell count was 43.88 ×10^9/L, with 18% neutrophils and 82% lymphocytes. Haemoglobin was 141 g/L and platelet count was …
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