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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 345:1558-1565 November 22, 2001 Number 21
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Case 36-2001— Acute Febrile Respiratory Illness in a 57-Year-Old Man with Recurrent Pulmonary Disorders
Raphael Dolin, and Eugene J. Mark

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Presentation of Case

A 57-year-old man was admitted to the hospital, for the sixth time, in January because of fever and cough.

The patient had a 25-year history of seronegative rheumatoid arthritis and a 20-year history of diabetes mellitus type 2, complicated by retinopathy and peripheral neuropathy. One year before the first admission (34 months before the current admission) bronchiolitis obliterans with organizing pneumonia was diagnosed on the basis of a biopsy (Figure 1). Treatment with prednisone in small doses improved the patient's dyspnea.

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Figure 1. Lung-Biopsy Specimen Obtained 34 Months before the Current Admission, Showing Features of Bronchiolitis Obliterans with Organizing Pneumonia . . . [Full Text of this Article]

 
Differential Diagnosis

Exacerbation of a Chronic Pulmonary Process

Opportunistic Infection after Immunosuppressive Treatment

Community-Acquired Pneumonia

Influenza

Other Respiratory-Virus Infections

Conclusions

Clinical Diagnosis

Dr. Raphael Dolin's Diagnosis

Pathological Discussion

Anatomical Diagnosis

References


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