TY - JOUR T1 - A puzzling tumour JF - Thorax JO - Thorax SP - 1116 LP - 1118 DO - 10.1136/thoraxjnl-2011-200829 VL - 67 IS - 12 AU - Achmed Kamara AU - Simon Dubrey AU - Majdi Osman AU - John Mikel AU - Gerrard Phillips Y1 - 2012/12/01 UR - http://thorax.bmj.com/content/67/12/1116.abstract N2 - 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 … ER -