An elderly man without history of travel presented with complaints of intermittent fever for 2 months, cough with scanty expectoration for 15 days and history of weight loss of 5 kg in 1 year. The chest X-ray and CT scan of the thorax showed dispersed centrilobular nodules and patchy subpleural consolidation in both lungs with mediastinal lymphadenopathy. He underwent bronchoscopy and bronchoalveolar lavage culture grew Pseudomonas aeruginosa. He was prescribed antibiotics based on culture sensitivity; however, patient continued to have symptoms. All relevant blood investigations were within normal limits. He underwent CT-guided biopsy of the right lung lesion during which clearing of the radio-opacities present in the initial CT scan and appearance of fresh lesions in different locations were observed. Migratory shadows were suspected. Fine-needle aspiration cytology showed features suggestive of coccidioidomycosis for which antifungals were started. After 1 month, he improved symptomatically and chest X-ray showed clearance of shadows.
A young adult male with no previous comorbidities presented with complaints of fever since 10 days and right cheek swelling since one week duration. Ultrasonography (USG) guided fine needle aspiration cytology (FNAC) of intraparotid lymph node showed ‘reactive lymphadenitis’. He was started on antibiotics and symptomatic treatment. He later developed breathlessness and desaturation following which he was shifted to the intensive care unit (ICU) and given non-invasive ventilation (NIV). Chest X-Ray (CXR) showed features suggestive of bilateral pneumonia. Mumps immunoglobulin-meta (IgM) was found to be positive. He improved over the next few days and was discharged.
A 48-year-old male, a known case of seizure disorder, presented with complaints of cough for four months, which increased for two weeks, fever for two weeks and weight loss. Computed tomography (CT) scan of the thorax showed multiple heterogeneously enhancing lesions of bilateral lung fields predominantly in peribronchovascular distribution with enlarged, necrosed and conglomerated lymph nodes suggestive of infective etiology. On routine blood investigations, he was found to be reactive for the human immunodeficiency virus. He underwent bronchoscopy and bronchoalveolar lavage culture grew Nocardia. He was prescribed antibiotics based on susceptibility reports and the patient became symptomatically better after one month and was discharged.
A young adult male with no previous comorbidities presented with complaints of fever since 10 days and right cheek swelling since one week duration. Ultrasonography (USG) guided fine needle aspiration cytology (FNAC) of intraparotid lymph node showed ‘reactive lymphadenitis’. He was started on antibiotics and symptomatic treatment. He later developed breathlessness and desaturation following which he was shifted to the intensive care unit (ICU) and given non-invasive ventilation (NIV). Chest X-Ray (CXR) showed features suggestive of bilateral pneumonia. Mumps immunoglobulin-meta (IgM) was found to be positive. He improved over the next few days and was discharged.
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