Abstract

This is a case study of a 61-year-old male admitted for cough and fevers. He was referred via his pulmonologist for pneumonia that was resistant to treatment and had positive findings on chest imaging. Imaging obtained from the patient’s pulmonologist showed right sided consolidation in the middle to lower lung lobes. Patient noticed a worsening dry cough, weight loss, night sweats, and malaise. The patient has been diagnosed with chronic obstructive pulmonary disorder (COPD) and was started on Trelogy in which he stopped due to minimal improvement. The patient went to see another pulmonologist and was told he had normal pulmonary function tests (PFTs). The patient is unsure if he has had COVID-19. He has received two COVID-19 Moderna vaccinations in January 2021. The patient reported fevers of >101°F, weight loss, malaise, dry cough, dyspnea on exertion, and worsening shortness of breath over the past month. Patient has a smoking history of 25 pack years and quit 21 years ago. Clinically, the patient was dyspneic on 2 liters of nasal cannula. Upon physical exam, the patient had diffuse crackles bilaterally. A complete blood count (CBC) showed a white blood cells (WBC) of 14,000 with an eosinophilic predominance of 33.9 percent and absolute eosinophil count of 4,730. The patient was subsequently tested for allergic disorders, parasitic diseases, fungal diseases, viral diseases, neoplastic disorders, autoimmune disorders, and eosinophilic disorders. The patient’s test results were negative for antinuclear antibodies (ANA), Streptococcus Pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), Strongyloides, Legionella antigen. The patient tested positive for Mycoplasma Pneumoniae Immunoglobulin G (IgG) and Immunoglobulin M (IgM). In addition, he underwent bronchoalveolar lavage (BAL) which showed, “Aveolar tissue with fribroblastic foci consistent with organizing pneumonia. Moderate mixed inflammatory infiltrate with predominance of eosinophils and neutrophils and few lymphocytes. Negative for Granulomas. Negative for atypia or neoplastic process.”