TY - JOUR T1 - Female patient with recurrent chest infections and non-resolving consolidation JF - Thorax JO - Thorax SP - 522 LP - 524 DO - 10.1136/thoraxjnl-2020-216168 VL - 76 IS - 5 AU - Eihab O Bedawi AU - Thomas Moore AU - Gareth D Turner AU - Mark McCole AU - Fergus V Gleeson AU - Najib M Rahman Y1 - 2021/05/01 UR - http://thorax.bmj.com/content/76/5/522.abstract N2 - A 45-year-old Caucasian woman was referred for investigation of recurrent chest infections. She had been treated over the previous 9 months for recurrent symptoms characterised by intermittent episodes of dyspnoea, cough productive of green sputum and pleuritic chest pain. Systemic enquiry was unremarkable; specifically, she had not experienced any weight loss or anorexia.On each episode, oxygen saturations were >94% and heart rate was <100 beats/min, with a single occurrence of a low-grade fever (37.8°C). The white cell count peaked at 10.59×108 (neutrophils 8.82, eosinophils 0.18, lymphocytes 0.89), and her C reactive protein remained consistently within normal lab ranges. She was not anaemic. Liver, kidney and bone profiles were all within normal limits.Each course of antibiotics would lead to transient improvement in cough, but the pleuritic chest pain and breathlessness remained unchanged.Her medical history included myasthenia gravis (1991), neuromyelitis optica (2009), non-alcoholic steatosis, hypertension, obesity (body mass index 48.7 kg/m2), hypothyroidism and obstructive sleep apnoea. Surgical history included thymectomy (1993) and a gastric bypass (2010).She worked in retail with no occupational exposures. She had never smoked and was teetotal. Her exercise tolerance had deteriorated over the preceding 12 months, from being unlimited to 50 m, due to a combination of dyspnoea and fatigue. She did not garden or tend soil, and had two cats in good health. She had no childhood respiratory illnesses. She lived with her young family in a suburban area and had no recent history of foreign travel. There was no personal or contact history of tuberculosis (TB).Medications included prednisolone, mycophenolate, lamotrigine, topiramate, lisinopril, venlafaxine, levothyroxine, omeprazole and pregabalin.Spirometry demonstrated an forced expiratory volume in 1 s of 1.9 litre (70% predicted) with forced vital capacity of 2.2 litre (72%predicted), similar to her results in the previous year. A contrast-enhanced CT scan of the thorax was … ER -