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Thorax 67:1116-1118 doi:10.1136/thoraxjnl-2011-200829
  • Chest clinic
    • Pulmonary puzzle

A puzzling tumour

  1. Gerrard Phillips5
  1. 1Department of Respiratory Medicine, Southampton University Hospitals NHS Trust, Southampton, UK
  2. 2Department of Cardiology, The Hillingdon Hospital, London, UK
  3. 3Department of Medicine, Southampton University Hospitals NHS Trust, London, UK
  4. 4Department of Histopathology, Dorset County Hospital, Dorchester, UK
  5. 5Department of Respiratory Medicine, Dorset County Hospital, Dorchester, UK
  1. Correspondence to Dr Achmed Kamara, Respiratory Medicine, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK; a.kamara.99{at}cantab.net
  1. Contributors AK and GP devised the idea for the case report; AK wrote the original manuscript; JM prepared the photomicrograph; SD, MO, JM and GP revised the manuscript.

Case

A 58-year-old never-smoker man developed dyspnoea, cough, fevers, weight loss and tremulousness over 4 weeks. He had a brief history of asbestos exposure. Significant medical history included autosomal-dominant polycycstic kidney disease (APKD) and renal transplantation 7 years previously. He took mycophenolate mofetil and tacrolimus immune-suppressants. Examination revealed tachypnoea, a fine right arm tremor, bronchial breathing on the right and a superficial 1×2 cm non-fluctuant lump over the abdomen. Lymph nodes were impalpable.

Screening blood tests showed values of c reactive protein 115 mg/l (NR <6.0), urea 25.8 mmol/l, creatinine 254 umol/l (post-transplant baseline 220–230) and tacrolimus 25.5×µg/l (NR 5–10). Autoimmune profile was negative. PCR detected cytomegalovirus (CMV) levels at 31 338 copies/ml. Plain chest radiography showed right upper lobe consolidation (figure 1A). An abdominal ultrasound scan revealed a normal transplanted kidney. Intravenous empirical antibiotics and oral valganciclovir, subsequently changed to intravenous …