A 68 year old gentleman, presenting with severe breathlessness, Tachycardia with a heart rate of 170/min and running a fever of 104 degrees.
Giving h/o breathlessness, cough with mucopurulent expectoration and low to moderate grade fever on and off since 3-4 years.
Absolutely denied smoking. But look at that clubbing!!! Differentials were Severe pneumonia, Pulmonary tuberculosis, or Chronic bronchiectasis.
CXR - showed a totally whitewashed right lung. Consolidtion? Tumor? (Didn’t have my trusty Sony Digicam. The picture was so worth a shot!!)
Workup was negative for active Kochs. Seven days of high antibiotics later the CXR pretty much cleared up, with remnants of what looked like fibrotic sequelae to old pulmonary Kochs at the apices of both lungs.
CT at cinched the diagnosis. Honeycombing s/o bronchiectatic changes secondary to old infections.
Final diagnosis - Massive Rt sided pneumonia in a case of Post -TB bronchiectasis.