Description

A 47-year-old unemployed man presented with a 2-week history of shortness of breath, dry cough and fever despite normal inflammatory markers and negative blood cultures. There was no weight loss or night sweats. He was a non-smoker and had no other medical history. HIV testing and tumour markers were negative.

Chest x-ray (figure 1A) showed what seemed to be a dense consolidation in the right mid-zone and lower zone. This was confirmed on CT (figure 1F), so wedge biopsies of the right middle and right lower lobes were taken via video-assisted thoracoscopy (VATS). There were no palpable lymph nodes and no evidence of significant mediastinal …