Peripheral lung infiltrates in a young woman.

(Chest 1992; 102:575-76) A 40-year-old woman was referred for evaluation of fever, cough, and chest pain. The patient had been entirely well until four months prior to presen tation, when she developed fevers, left-sided chest pain, and a cough productive of minimal amounts of rust-colored sputum . The sputum production cleared after two days, but the fever persisted. A chest roentgenogram demonstrated a “ground-glass― lingu lar infiltrate. Empiric antibiotic therapy with erythromycin fol lowed by a cephalosporin failed to achieve complete resolution of the patient's symptoms. Two weeks after discontinuation ofthe antibiotics, her cough worsened, and she was seen by a pulmonologist; at this time the lingular infiltrate had resolved, but an ill-defined density was seen in the left lower lobe. She received another course of erythromycin, but reported no improvement in symptoms. Laboratory data at that time revealed an elevated erythrocyte sedimentation rate (ESR) and peripheral blood eosinophilia of 18 percent. Physical examination demonstrated wheez ing. She received some benefit from prednisone started at a dose of 10 mg/d, but her symptoms returned shortly after the drug dosage was tapered three weeks later. Her wheezing and cough then responded to inhaled beta-agonists and corticoste roids, but her malaise was so profound that she could not continue to work. The patient's medical history revealed no childhood FIGuRE 1