Case 279

Medical history

Female patient, 36yo, presenting hemoptysis, wheezing and progressive dyspnea, Modified Medical Research Council Dyspnea Scale (mMRC) = 3, for 2 months. Negative epidemiology for tuberculosis. She denies smoking. Hospitalization for pneumonia two years ago. At examination, SpO2 = 98% (nasal catheter with oxygen at 2L/min). Negative HIV rapid test and BAAR in sputum. High-resolution computed tomography (HRCT) as presented.

In face of clinical history and HRCT, which diagnosis is the most likely?

Test question

(Medical Residency 2015 - UniRio - Direct Access)  Patient using macrodantine, with no previous history of asthma, started cough, fever and dyspnea on exertion, with diffuse crepitant wheezing in pulmonary auscultation. Pulse oximetry demonstrates mild hypoxemia and chest tomography, airspace condensation areas and bilaterally and diffusely "ground glass" opacities.

The main diagnostic hypothesis for this case is:

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