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A 44-Year-Old Man With Right Limb Convulsion and Cavitary Lung Lesion With Diffuse Interstitial Abnormalities
Jiaxin Zhou1, Qing Yu1, Li Gao2
1Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China.
A 44-year-old man with asthma developed neurological and respiratory symptoms. Imaging revealed brain and lung lesions, suggesting an infectious or neoplastic process requiring further investigation.
Area of Science:
- Neurology
- Pulmonology
- Infectious Diseases
Background:
- A 44-year-old male with asthma presented with a 2-month history of neurological and respiratory symptoms.
- Symptoms included intermittent right-sided limb convulsions, afternoon fevers, decreased exercise tolerance, productive cough, and significant weight loss.
Observation:
- Initial workup revealed left parieto-occipital lobe low-density brain lesions and a right upper lobe lung cavity.
- Chest CT showed bilateral diffuse interlobular septal thickening and multiple patchy ground-glass opacities.
- Both brain and lung lesions were avid on 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (PET/CT) scan.
Findings:
- Bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy were nondiagnostic.
- The patient experienced progressive dyspnea and increased seizure frequency, correlating with lesion progression on follow-up CT scans.
Implications:
- The case highlights a diagnostic challenge in a patient with multifocal brain and lung lesions.
- Further investigation is crucial to determine the etiology, potentially an opportunistic infection or malignancy, in immunocompetent individuals.
- Timely diagnosis and treatment are essential given the progressive nature of the disease.
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