Clinical Case

1. Clinical Case Leonor Meira, Susana Guimarães, Conceição Souto Moura, José Miguel Jesus, Rui Cunha, Patrícia Mota, Natália Melo, António Morais

2. IDENTIFICATION CASE #5 • AJVM • Male • 53 years old • Caucasian • Geothermic engineer: • worked in silver, gold and coal mines. • Nowadays works in construction

3. PREVIOUS MEDICAL HISTORY • No clinical events during childhood • Current smoker (37PY) • No usual medication • No surgical history • No allergies • Occasional alcohol consumption; no drugs consumption • No family history of pulmonary diseases

4. PREVIOUS MEDICAL HISTORY • No contact with birds or other animals • No recent travels abroad • No history of contact with tuberculosis • No sexual risk behaviours • No history of blood transfusions

5. HISTORY OF PRESENT ILLNESS • The patient referred chronic dry cough • He denied other signs/ symptoms such as: • Dyspnoea, chest pain, wheezing, haemoptysis • Weight loss, anorexia, malaise • Fever, nigh sweats • GP routine visit: • Chest XR: hyperinflation, increase in interstitial markings Pulmonology outpatient clinic FEB 2015

6. PHISICAL EXAMINATION • ON ADMISSION: • No fever • Normal HR and BP • No digital clubbing • No respiratory distress. SpO2 (FiO21%): 98% • Cardiac auscultation: no abnormalities • Chest auscultation: bibasilar inspiratory crackles, mainly on the right • No other signs were found during PE

7. DIAGNOSTIC TESTS • BLOOD ANALYSIS

8. DIAGNOSTIC TESTS • BLOOD ANALYSIS

9. DIAGNOSTIC TESTS • LUNG FUNCTION TESTS

10. DIAGNOSTIC TESTS • CHEST HRCT – MAY 2015 “(…) Panlobular and paraseptal emphysema, mainly in the upper lobes, peripheral GGO in lower lobes (…)”

11. DIAGNOSTIC TESTS • CHEST HRCT – MAY 2015 “(…) Panlobular and paraseptal emphysema, mainly in the upper lobes, peripheral GGO in lower lobes (…)”

12. DIAGNOSTIC TESTS • CHEST HRCT – MAY 2015 “(…) Panlobular and paraseptal emphysema, mainly in the upper lobes, peripheral GGO in lower lobes (…)”

13. DIAGNOSTIC TESTS • CHEST HRCT – MAY 2015 “(…) Panlobular and paraseptal emphysema, mainly in the upper lobes, peripheral GGO in lower lobes (…)”

14. DIAGNOSTIC TESTS • CHEST HRCT – MAY 2015 “(…) Panlobular and paraseptal emphysema, mainly in the upper lobes, peripheral GGO in lower lobes (…)”

15. DIAGNOSTIC TESTS • CHEST HRCT – MAY 2015 “(…) Panlobular and paraseptal emphysema, mainly in the upper lobes, peripheral GGO in lower lobes (…)” Suggestive NSIP

16. CLINICAL EVOLUTION OCT 2015 Stopped smoking • CRYOBIOPSY • FLEXIBLE BRONCHOSCOPY No endobronchial lesions BL and BAL fluid specimens were smear and culture negative for common bacteria and acid-bacilli

17. CLINICAL EVOLUTION OCT 2015 Stopped smoking Smoking related interstitial fibrosis • CRYOBIOPSY • FLEXIBLE BRONCHOSCOPY No endobronchial lesions BL and BAL fluid specimens were smear and culture negative for common bacteria and acid-bacilli

18. CLINICAL EVOLUTION FEB 2016 OCT 2015 Patient without respiratory symptoms Maintains vigilance Stopped smoking • FLEXIBLE BRONCHOSCOPY No endobronchial lesions BL and BAL fluid specimens were smear and culture negative for common bacteria and acid-bacilli