L tropical lung disease - - Hemoptysis in a 4 . Year - Old Man * An Unusual Presentation of a Sporadic Disease

A 49-sear-old man came to) LAG-USC Medical Center with a sixweek history o)fblood-streaked sputum. During the preceding three weeks he had lost 22 pounds in weight. He complained of general fatigue, occasio)nal occurrences offever, chills and night sweats. He had no cough, shortness of breath, abdominal pain or cramping. Three weeks before presentation he experienced diarrhea, which lasted for five days amid subsided without any treatment. On this visit to) the hospital he had a dull ache in the right lo)wer po)sterlo)r thorax. He had no previous o)perations o)r hospital admissions. He did not know if any O)f his friends or family members had had tuberculosis. A gardner by profession, the patient has resided in the United States for eight years with occasio)nal travel to) Mexico. He smoked one half pack o)f cigarettes per day for 20 years. He was an alcoholic but gave up the habit about 15 years prior to this visit to) LAC-USC Medical Center. He did not visit pro)stitutes and denied IVDA and homosexual contact. On physical examinatio)n he was alert, cooperative and did not appear cachetic. His temperature was 38.8#{176}C.The breath so)unds were diminished over the lower base of the right lung and a few crackles were present. Results o)f the rest o)f the examination were normal. Bloxxl tests that yielded abnormal results included the following: alkaline phosphatase level, 259 units/L (normal:<110 t,nits/L); a calcium value, 8.0 nig % (normal:S.5-10.5 mg/100 ml); to)tal pro)teiml level, 6.2 g % (normal:6.5-9 g/100 ml); albumin value, 2.5 g % (normal:3.5-5.0). The white l)lood cell count was mildly elevated (13.9/cu mm,/g/100 ml), with a differential cell count of63 percent segmented neutrophils, 15 percent hand cells, 15 percent lymphocytes and 7 percent mo)nocytes. The hematox’rit value was 24.7 percent with a MCV of 85.7. with pleuropulmonary amebiasis who complained of hemoptysis but had no gastrointestinal symptoms. This rather unusual presentation caused a considerable delay in securing the diagnosis. (Chest 1990; 98:1275-78)