Case Discussion

A 24-year-old university student presents to the Student Health Service with a 3-day history of a dry cough that was initially non-productive but has become productive of scant white sputum. The patient also complains of malaise, headache, fever and muscle aches and pains. The patient did not have any other upper respiratory tract symptoms before this illness began. (no rhinorrhea, no sore throat, no conjunctivitis, and so on)

What is upper respiratory tract? What is lower respiratory tract? What are the symptoms of disease in upper and lower respiratory tracts?

The patient has had no episodes like this in the past; however his roommate developed the same symptoms 2 days ago. On examination, the patient has a temperature of 39 degrees. BP: 20/80. Pulse: 75/minute. RR: 22 /minute. You hear few scattered rales in the left lung base. No other abnormalities are found.

What is the pathological process? What are the possible causes of this pathology?

CBC: Hg normal, WBC: 15,000 Chest X-ray: Patchy lower lobe infiltrates The patient received a course of erythromycin and improved within few days

Describe the expected morphological findings (microscopy) in the lungs of this patient with pneumonia. What are the possible outcomes of pneumonia?

Case

A 55-year-old female, previously healthy and recovering from an episode of bronchitis, suddenly develops a “shaking chills” followed by the onset of a high fever 40 degrees, pleuritic chest pain, and cough productive of purulent sputum.

On examination, the patient appears ill. Her respiratory rate is 30/minute. Bronchial breath sounds are heard in the left lower lobe. Chest x-ray reveals consolidation present in the left lower lobe.

What is the pathological process? What are the possible causes of this pathology?

Case

Mohamed is a 31 year old man from India. He presents with cough with yellow sputum for one month. He has seen a doctor 2 weeks ago, who thought that he has bronchitis or pneumonia and gave him antibiotics. But he did not improve. Mohamed feels tired and weak for the last 2 month. He was not eating well. He misses his family, and he lost a lot of weight.

Mohamed moved to Saudi one year ago, and he works as chef in a restaurant. He did not notice any fever, but he felt sweaty during the night. He had no chest pain or shortness of breath. He did not have any recent travel.

Mohamed appeared thin. Pulse: 68. BP: 120/80. His temperature is 38.5 degrees Chest examination is normal, but he continued to chough during the examination. Heart and abdomen are normal.

CBC: normal Liver function test: normal Chest x-ray: cavitary lesion in the right lower lobe. Mantoux tuberculin skin test is positive.

Mohamed was referred to a respirologist who arranged bronchoscopy for him. At the time of bronchoscopy old blood was seen coming out of the left upper lobe with some inflammation. Biopsy was taken. The biopsy showed necrotizing granulmatous inflammation.

What is granuloma? What are the types of grnuloma? What are the causes of granuloma?