Cough and Dyspnea in a Renal Transplant Patient

 

Ashish Khandelwal,* Naman Desai, Fernanda Cabral, and Sachin Saboo

  DOI 10.5001/omj.2014.101  
 
 

Department of Radiology, Brigham and Women’s hospital, Harvard Medical School, Boston, 75 Fancis Street, MA 02115.

Received: 14 Jun 2014
Accepted: 15 Aug 2014

*Address correspondence and reprints request to:   Ashish Khandelwal, Department of Radiology, Brigham and Women’s hospital, Harvard Medical School, Boston, 75 Fancis Street, MA 02115.
E-mail: drashish83@gmail.com
 
 
 

How to cite this article

Khandelwal A, Desai N, Cabral F, Saboo S. Cough and Dyspnea in a Renal Transplant Patient. Oman Med J 2014 Sep; 29(5):380.

How to cite this URL

Khandelwal A, Desai N, Cabral F, Saboo S. Cough and Dyspnea in a Renal Transplant Patient. Oman Med J 2014 Sep; 29(5):380Available from http://www.omjournal.org/fultext_PDF.aspx?DetailsID=574&type=fultext


 

 

 

Introduction

A 38-year-old male presented with cough and dyspnea for approximately one month. He had a past medical history of hypertension, end-stage renal disease secondary to unspecified glomerulonephritis, and living-donor renal transplant 15 years ago. He had no history of exposure to tobacco or occupational toxins. His blood tests revealed increased serum creatinine (3.0 mg/dL), normal phosphate (4.0 mg/dL) and calcium levels (9.7 mg/dL), increased parathyroid hormone (95 pg/mL), and low calcidiol (10.2 ng/mL) and calcitriol (8.1 ng/mL) levels. The patient underwent bronchioalveolar lavage, which was negative for mycobacterial or fungal infection. Chest radiograph revealed fluffy densities involving the upper and mid lobes bilaterally with sparing of the subpleural region (Fig. 1). An axial computed tomographic scan of the chest showed extensive, upper lobe predominant ground glass opacities in an acinar distribution with areas of calcification. (Fig. 2, a and b)

f1

Figure 1: Chest radiograph showing fluffy densities involving the upper lobes bilaterally with sparing of the cortex (black arrow).

f2 

Figure 2: Coronal computed tomographic scan of chest in a) Mediastinal window b) lung window showing extensive, upper and middle lobe predominant ground glass opacities in an acinar distribution with areas of calcification with subpleural sparing (black arrows).

Questions

1. What is the diagnosis?

2. How do you treat it?

To access the full article, please complete the quiz online at www.omjournal.org