Abstract We present the case of a 62 year old male, never-smoker, with no relevant past medical history who initially presented to his PCP in January of 2025 for productive cough and shortness of breath. He was treated with Levaquin, however did not note any improvement in his symptoms. He presented to the ED in February of 2025 for ongoing SOB and cough, where a CT PE was done that showed a large region of consolidation in the left lower lobe, thought to be pneumonia. The patient was hemodynamically stable and required no supplemental oxygen, so he was discharged on Augmentin and Doxycycline, and given strict return precautions and outpatient follow up. The patient saw his PCP and convenient care numerous times in the next few months and was placed on various antibiotics, steroid tapers, and inhalers with no improvement in his symptoms. A repeat CT was ordered in May that showed the same large consolidation in the lower lobe along with new patchy airspace disease throughout both lungs. Due to this, he was referred to pulmonology. He underwent an endobronchial ultrasound with biopsy, and he did require significant supplemental oxygen post-procedure and was admitted to the hospital to be qualified for home oxygen. The results of the biopsy showed mixed acute and chronic inflammation, but was overall benign. Due to his bronchoscopy results and infiltrates on CT scan, the patient was clinically diagnosed with Cryptogenic Organizing Pneumonia and started on a steroid taper. Two months after his biopsy, the patient presented to the ED with increased shortness of breath and hypoxia requiring high flow nasal cannula. Repeat CT showed persistent bilateral ground-glass and consolidative opacities that were similar to previous. Discussion was had with the patient about the next steps, and a decision was made to pursue a surgical biopsy. Interventional Radiology did not feel there was a good target, so Cardiothoracic Surgery performed a high-risk thoracotomy. The immediate preliminary pathology was concerning for malignancy. Unfortunately, after the procedure the patient was unable to be weaned from the vent, and passed away in the ICU. His final pathology yielded Mucinous Adenocarcinoma. This case points to the importance of keeping a broad differential, and not making final decisions off of a negative biopsy. This abstract is funded by: None
Buntic et al. (Fri,) studied this question.