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A 52-year-old male smoker presented with a 2-month history of progressive breathlessness and weight loss. He denied having cough, wheeze, hemoptysis or fever. Although tachypneic (rate 26/min), he was maintaining saturation of 97% breathing room air. Chest radiograph showed multiple bilateral patchy nodular opacities with left-sided pleural effusion. Xpert MTB/Rif assay of induced sputum was negative for Mycobacterium tuberculosis. Pleural fluid was exudative, predominantly lymphocytic (90%) and devoid of malignant cells. Pleural fluid adenosine deaminase (ADA) was 28 IU/L. Thoracic CT scan showed multiple nodules predominantly non-cavitating, with confluent alveolar fluffy opacities distributed in both lung fields. Left-sided pleural effusion with some pleural nodularity was also evident (figure 1). Bronchoscopy ruled out the presence of any endobronchial lesion; subsequent bronchoalveolar lavage (BAL) sent for bacterial and fungal cultures turned …
Contributors SrS is responsible for collection of data and writing of initial draft of manuscript. SaS critically reviewed the manuscript to its final shape before submission to the journal. Both were involved in the management of the patient and have reviewed the final manuscript before submission to the journal.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests We declare SaS as the guarantor for the overall content of the manuscript.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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