A puzzling tumour
- 1Department of Respiratory Medicine, Southampton University Hospitals NHS Trust, Southampton, UK
- 2Department of Cardiology, The Hillingdon Hospital, London, UK
- 3Department of Medicine, Southampton University Hospitals NHS Trust, London, UK
- 4Department of Histopathology, Dorset County Hospital, Dorchester, UK
- 5Department of Respiratory Medicine, Dorset County Hospital, Dorchester, UK
- Correspondence to Dr Achmed Kamara, Respiratory Medicine, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK;
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.
- Asthma mechanisms
- COPD pathology
- pulmonary embolism
- asbestos induced lung disease
- occupational lung disease
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 …