Bilateral cavitary lung disease in a 29-year-old woman.

A 29-year-old black woman was admitted for evaluation of fever and productive cough of one month’s duration. She also complained of occasional hemoptysis, mild shortness of breath, and night sweats. She had a weight loss of9 kg over the preceding six months. She had had one previous hospital admission for pelvic inflammatory disease in 1981, at which time a routine chest roentgenogram was said to have been abnormal. There was no other past history of illness and no known history of exposure to tuberculosis. She was taking no medication and had no allergies. She had a five pack-year history of smoking and was a nondrinker. Physical examination results on admission showed the following: mild respiratory distress; pulse rate, 108 beats/mm and regular; blood pressure, 100/60 mm Hg; respirations, 36 breaths/mm; and temperature, 39#{176}C. Dentition was normal. Examination of the lymph glands revealed a firm, 2.0-cm left supraclavicular node. On chest examination, bronchial breathing was noted in the left upper lung field posteriorly. The rest of the examination results were normal. Complete blood count showed a WBC count of 7.1/ cu mm, with a normal differential and a hemoglobin of 10.5 g/dl. Serum electrolytes, BUN, and creatinine all were normal. Liver-associated enzymes were normal. Chest roentgenogram showed bilateral upper lobe parenchymal disease with volume loss and a cystic abnormality at the right apex. Right paratracheal adenopathy and right paraspinal widening were also noted (Fig 1).