A 56-Year-Old Man With Cough, Bloody Sputum, and Lithoptysis

A 56-year-old Chinese man, who did not smoke, presented with a 2-month history of cough and bloody sputum. He also complained of fatigue, night sweats, chest pain, and shortness of breath, with no chills or loss of weight. He previously worked as a veterinarian and had been infected with Brucella 30 years ago. Additionally, he had been diagnosed with tuberculous pleurisy and completed a 1-year anti-TB treatment. Subsequently, he had been well until 2 months before the current admission. A chest CT scan showed a cruciform calcification in the mediastinum and some tree-in-bud changes. The results of the purified protein derivative skin test and interferon-gamma release assay for TB were negative. Brucella agglutination test was also negative. On the night of admission, the patient coughed up two silver-white-colored shiny stones and had a fever of up to 38.5 °C on the following days.