What’s Causing This Persistent Cough?

A 75-year-old female presents with a two-year history of a persistent cough and fatigue. The cough is occasionally productive of purulent sputum. She was treated for a community-acquired pneumonia two years earlier and underwent an anterior cervical discectomy and fusion previously, but is otherwise well. On examination, she appears well-groomed, polite, and thin. Chest auscultation reveals wheezing in the mid zones bilaterally and a later chest X-ray and CT scan demonstrate the findings seen here.

a. Klebsiella pneumoniae
b. Pseudomonas aeruginosa
c. Aspergillus fumigatus
d. Mycobacterium avium-intracellulare

Find the answer, discuss this case, and more on Figure 1.

Explore cases, quiz yourself, and solve medical mysteries along with thousands of other medical professionals around the world on Figure 1, the free app where doctors expand their clinical knowledge.

Discussion