A 72-Year-Old Man With Innumerable Bilateral Pulmonary Nodules After Lung Transplantation

A 72-year-old man who underwent bilateral orthotropic lung transplantation for interstitial lung disease 6 months ago presented to the clinic with a 2-week history of cough, shortness of breath, and mid-back pain. The donor was negative for cytomegalovirus (CMV) and positive for Epstein-Barr virus (EBV), and the recipient was positive for both CMV and EBV. He also reported headaches but denied any fever, chills, weight loss, night sweats, chest pain, orthopnea, paroxysmal nocturnal dyspnea, or leg swelling. His other medical history included renal cell carcinoma, for which he had undergone partial right nephrectomy 6 years earlier. The patient lived in central Florida and denied any recent travel to the fungal endemic areas or international travel. He never suffered from TB or had any exposure to patients with TB. His immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil, and prednisone. The targeted tacrolimus trough level was 10 to 12 ng/mL, and the patient was generally in the therapeutic range.