A 72 y/o male with a PMH of gout and hyperlipidemia presents to the clinic for chronic persistent cough, dyspnea on exertion and a 50 lb weight loss over the past 4 months.
His cough is mostly dry and reports no recent URTIs/LRTIs. He also complains of night sweats for the past few weeks. He denies having any fevers, headache, blurry vision, chills, N/V, chest pain, palpitations, hemoptysis, orthopnea, diarrhea, constipation, urgency urination or other medical complaints, and has no recent travel history. He has been a professional boxer throughout his life. He stopped training 2 months ago because of his cough and dyspnea.
VSS
Patient appears fatigued and weak. Physical examination is unremarkable.
He is currently not taking any medications.
Smoking history: 20 pack years
He denies consuming alcohol or other drugs.
Family history is unremarkable.
Labs:
WBC 21.1
RBC 4.7
Hb 11.1
MCV 75
Platelets 621
ESR 100
HbA1c 6.2
Cr 0.93
Na 134
K 4.9
Cl 99
HCO3 27
Iron 30 (Low)
Ferritin 654 (High)
TSH 3.2
Rheumatoid Factor 127 (normal: < 14)
Anti CCP, Centromere, SS-A, SS-B, Scl 70, dsDNA antibodies: Negative
HIV Ag/Ab: non reactive
CT thorax attached below.
What are your most likely diagnosis and differentials?
Thank you @Nader Guma please provide a follow up on the work up that was done and update us once the diagnosis is established