A solitary pulmonary nodule with zoonotic implications.

A n 82-year-old white man presented with a chief complaint of productive cough without hemoptysis. He denied chest pain, dyspnea, wheezing, fevers, rigors, night sweats, weight loss, or recent travel. His medical history was notable only for bilateral venous stripping of the lower extremities 40 years ago. He was not taking any prescription medications, over-the-counter medications, herbs, or supplements. Sulfa drugs caused a rash. He denied alcohol abuse or ever smoking. He retired as a diemaker without any chemical exposures. He denied having any pets. His father died at age 65 of lung cancer. Physical examination revealed a BP of 115/71 mm Hg, pulse rate of 90 beats/min, respirations of 18 breaths/min, and a temperature of 36.7°C. The lungs were clear to auscultation without egophony or wheeze. The head, neck, cardiac, abdominal, neurologic, and dermatologic examinations were all unremarkable. The WBC count was 7 3 10/L, with a normal differential and without eosinophilia. A chest radiograph revealed a solitary noncalcified left upper lobe pulmonary nodule (Fig 1) that was not present on previous chest radiographs dating back to 1991. CT confirmed a single noncalcified, well-circumscribed left upper lobe nodule measuring 1.3 3 1.3 cm (Fig 2). The patient underwent a video-assisted thoracoscopic wedge resection. The histopathologic examination revealed the diagnosis (Fig 3).