CASE FOR DIAGNOSIS Upper lobe infiltrate with cough, fever, fatigue

A 41 yr old housewife, orig ina lly from Sicily, presented in June 1990 with a fever of five months duration, dry cough and fatigue. She denied present or previous occupational risks as we.ll as travel outside ftaly during the previous J 0 yrs. The patient appeared in good condition; physical examination was negative for superficial lymph adenopathy. hepatosplenomegaly and pulmonary findings. A left upper lobe pulmonary opacity was detected at another hospital on routine chest roentgenogram; a fi ne-needle aspiration-biopsy was not diagnostic. Laboratory tests were within nom1al range with the exception of erythrocyte sedimentation rate (ESR) (43 mm·h·) and of a mild hypochromic microcytic anaemia (Hb= 95 g·/' ; mean corpuscular volume (MCV)=74 J.l.~; blood iron= 230 J.l.g·/·1). Anti-human immunodeficiency virusI (HIV -I) specific antibodies were repeatedly negative by enzyme immuneassays . Circulating CD4+ cells were normal in number (1, li5·J.l.l·) and CD4/CD8 ratio was 2.18.