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A 26-year-old woman presented with a history of chronic progressive dyspnoea and a non-productive cough. Her medical history revealed recurrent, unexplained pneumonias and treatment for anorexia nervosa. The patient was a lifelong non-smoker and she denied any use of toxic substances.
On examination, her vital signs were as follows: body mass index, 17.6 kg/m2; temperature, 38.4°C; heart rate, 102 beats/min; BP, 100/60 mm Hg; respiratory rate, 24 breaths/min; and oxygen saturation, 91% on 6 L/min oxygen by nasal cannula. On auscultation, decreased breath sounds were heard at the bases bilaterally.
Blood testing for antinuclear antibodies was negative and immunological analysis demonstrated no immunodeficiency. Pulmonary function tests showed a restrictive pattern (total lung capacity: 3.72 L, 73% of predicted). A CT scan of the chest revealed bilateral consolidations with air bronchograms and a tree-in-bud-pattern (figure 1). A bronchoscopy …
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