Golf Vacations

oh_hell_imagine_that asked:


A 52-year-old man presents to the office for the evaluation of a cough and fever. He has had these symptoms for about a week. He has also noted a sharp chest pain that is worse when he coughs or takes a deep breath. He has had some associated fatigue, headaches, achy joints, and sweatiness at night. He has been using an over-the-counter flu medication, which helps to reduce the cough, but he wanted to be checked because his symptoms are lingering. He has no history of pulmonary diseases and has never smoked cigarettes. He has had no exposure to ill contacts. His only recent travel was a weeklong golf vacation to Phoenix, which he took 3 weeks ago. On examination, he is comfortable appearing and in no respiratory distress. His temperature is 37.7oC (99.9oF), and his vital signs are otherwise normal. His pulmonary examination is notable for some faint expiratory wheezing and crackles in the left upper lung field. The remainder of his physical examination is unremarkable. A CBC shows a normal total white blood cell count but with a high percentage of circulating eosinophils. Microscopic examination of a fresh sputum sample treated with KOH reveals numerous spherules.

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