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Pulmonary puzzles
A good night for a bad day
  1. L Guilleminault1,2,3,
  2. M-H Sigmann4,
  3. F Paganin1
  1. 1Service de Pneumologie, CHU Reunion/GHSR, Saint-Pierre, France
  2. 2Inserm, UMR 1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), plateforme CYROI, Sainte-Clotilde, France
  3. 3Université de La Réunion, UMR 1188, Sainte-Clotilde, France
  4. 4Service de Radiologie, CHU Reunion/GHSR, Saint-Pierre, France
  1. Correspondence to Dr L Guilleminault, Service de Pneumologie, CHU Reunion/GHSR, BP 350, Saint-Pierre cedex 97448, France; laurent.guilleminault{at}

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A 40-year-old-man was admitted to the emergency department for sudden dyspnoea. He had no medical history. He had given up smoking a few years back having had a cigarette consumption of 10 packs/year. He stopped drinking alcohol 2 months ago. He had been a drug (heroin and cocaine) misuser for 15 years. Methadone had been introduced as a substitution therapy since 2012. He came back from a journey to China 1 month beforehand. The day of admission, he awoke with dyspnoea and a dry cough.

In the emergency room, he had no fever, and lung and cardiac auscultation was normal. Oxygen saturation was 94% and the respiratory rate was over 20/min. Laboratory findings showed an increase in the leucocyte count at 18.1 109/L. …

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