Case 4-2003

Presentation of CaseA 42-year-old woman was admitted to the hospital because of a productive cough, chills, and fever.The patient had been well until seven months earlier, when an intermittent, generally nonproductive cough developed and did not resolve, despite courses of several antibiotics. A chest radiograph was said to be unremarkable. A few months before admission, another chest radiograph was believed to show a hiatal hernia, but a barium-swallow examination failed to reveal the hernia. Several days before admission, the patient began to cough up green, foul-smelling sputum and had a temperature as high as 38.5°C, without chills or . . .