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A 42-year-old Malay man presented with cough productive of yellowish sputum, hoarseness and intermittent daily fever associated with chills and rigours for 3 weeks. Apart from previous pulmonary TB in 1994 for which treatment was complete, there were no other comorbidities. The patient was an active cigarette smoker of 20 pack-years, and worked as an outdoor project coordinator frequently in contact with soil during field surveys in gardens. Chest radiograph showed right perihilar consolidation (figure 1A). CT thorax showed mass-like consolidation of the right upper lobe with extensive mediastinal lymphadenopathy (figure 1B). White cell count was 8.8 (range 3.4–11.0×109/L) with neutrophilia 72.2%; blood, sputum and urine for bacterial cultures, as well as sputum for acid fast bacilli smears and TB PCR assay, were negative. Random blood sugar level was 23.0 mmol/L (range 4.0–7.8 mmol/L) and glycated haemoglobin level was 12.1%. Bronchoscopy showed mobile …
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