A 62-year-old man with hypotension and a large chest fluid collection

Abstract

A 62-year-old man was admitted with increased shortness of breath and a cough associated with yellowish sputum production. His symptoms had been progressively worsening over weeks. Pertinent symptoms at presentation included a 10-lb weight loss, dizziness, and low-grade fevers.

The patient was being followed up in pulmonary clinic for a left lung fluid collection shown in Figure 1. A workup had been initiated. Purified protein derivative results and three sputum tests for acid-fast bacilli were negative. Bronchoscopy showed no endobronchial lesions. BAL grew Streptococcus pneumoniae and Stenotrophomonas maltophila. Bronchoscopic mycobacterial and fungal culture findings were negative. No atypical cells were seen. He was treated with trimethoprim-sulfamethoxazole and levofloxacin indefinitely and was referred to the thoracic surgeons. However, he was unavailable for follow-up. His chronic health problems were non-insulin-dependent diabetes mellitus, chronic pancreatitis, hypertension, emphysema, and gastroesophageal reflux disease. His medications included glipizide, albuterol/ipratropium inhaler, lisinopril, and esomeprazole.