A 42-year-old man with progressive cough, fever, and shortness of breath for three weeks. Here are the key points and findings:
Medical Conditions: Hyperlipidemia and hypertension.
Medications: Atorvastatin 20 mg daily, lisinopril 10 mg daily.
Lifestyle: Non-smoker.
Recent Activity: Recently placed mulch in his yard.
Physical Examination:
Temperature: 38.5°C (101.3°F)
Heart Rate: 117 beats per minute
Respirations: 32 per minute
Oxygen Saturation: 88% on room air
Lung Examination: Crackles in both lung bases, no wheezing or prolonged expiration.
Laboratory Studies:
Hematocrit: 42.7% (normal range 42%–50%)
Leukocyte Count: 13,500/µL (elevated; normal range 4000–11,000/µL)
Neutrophils: 82% (elevated; normal range 50%–70%)
Lymphocytes: 15% (decreased; normal range 30%–45%)
Monocytes: 2% (normal range 0%–6%)
Eosinophils: 1% (normal range 0%–3%)
Platelet Count: 350,000/µL (normal range 150,000–450,000/µL)
Imaging and Other Findings:
Chest Radiography: Bilateral diffuse mixed ground-glass and reticular opacities.
BAL (Bronchoalveolar Lavage) Fluid Analysis: 60% lymphocytes, 26% eosinophils.
Cultures: No microorganisms or malignant cells found.
Viral Panel: Negative.
Interpretation:
The combination of progressive respiratory symptoms, bilateral ground-glass and reticular opacities on chest radiography, and BAL fluid analysis showing a high percentage of lymphocytes and eosinophils suggests a diagnosis of Hypersensitivity Pneumonitis (HP). This condition can occur in response to inhalation of organic dust, which is consistent with the patient's history of placing mulch in his yard, a potential source of organic dust and other allergens.