An African American Man in His Late 30s With Lung Cancer Presenting With Persistent Cough and Hemoptysis Anirudh Aron, MD; Upasna Manchanda-Aron, MD; and Scott E. Sinclair, MD, FCCP CASE PRESENTATION: An African American man in his late 30s was referred to the pulmonary clinic for evaluation of a persistent cough of several weeks’ duration. Cough was productive of mucopurulent sputum mixed with blood. He also noted generalized weakness and dyspnea with minimal exertion. CHEST 2017; 152(1):e11-e14 Five months prior to this presentation, the patient was diagnosed with combined small cell and large cell lung carcinoma when he presented with dry cough, right- sided chest pain, and dyspnea. Chest imaging showed a lingular mass and bulky extensive bilateral mediastinal lymphadenopathy. Six weeks prior to the current presentation, he had completed five cycles of systemic platinum doublet chemotherapy (cisplatin, paclitaxel, bevacizumab) and concurrent external beam radiation therapy to the mediastinum for stage IIIb disease (T2bN3M0). Subsequent to this, he was admitted twice with pneumonia and treated with empirical antibiotics, but the cough persisted. He had never smoked and worked as a truck driver with occupational exposure to diesel fumes. Physical Examination Findings Vital signs were normal and oxygen saturation was 97% on room air. Physical examination was unremarkable except for coarse rhonchi over both lung bases. Diagnostic Studies Laboratory evaluation showed mild anemia (hemoglobin, 11 g/dL) and leukocytosis (WBC count, 13,800 /mL). The chest radiograph showed the known peripheral lingular mass at the left lung base, which was not as well seen as previously, and there were no new findings (Fig 1). A CT scan of the chest showed multifocal tree-in-bud opacities and patchy areas of consolidation bilaterally, favoring the middle and lower lungs (Fig 2); these findings were worse compared with chest CT performed approximately 4 weeks earlier. The anterior wall of the proximal left main bronchus was Figure 1 – Chest radiograph showing the known peripheral lingular mass at the left base. AFFILIATIONS: From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Aron and Sinclair), University of Tennessee Health Science Center; and Department of Infectious Disease (Dr Manchanda- Aron), Baptist Memorial Hospital, Memphis, TN. CORRESPONDENCE TO: Anirudh Aron, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, 956 Court Ave, Ste G-228, Memphis, TN, 38163; e-mail: aaron2@uthsc.edu Copyright Ó 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: http://dx.doi.org/10.1016/j.chest.2016.12.013 [ Pulmonary, Critical Care, and Sleep Pearls ] chestjournal.org e11