Abstract
A 17-year-old male presented with subacute onset of cough, fever, dyspnea, and weight loss. He had no unusual exposures, but had been taking minocycline for 6 months for acne. His initial chest X-ray revealed patchy bilateral airspace consolidations. He was treated with azithromycin and then amoxicillin/clavulanate, but due to lack of improvement, he was prescribed ciprofloxacin and had a chest computed tomography (CT) that revealed bilateral multifocal consolidations with a predominant peripheral and subpleural distribution. He was then referred to pulmonology. Laboratory studies were significant for 8.0% eosinophilia and negative infectious workup. Initial plethysmography revealed a restrictive pattern (FEV1 55%, forced vital capacity [FVC] 48%, total lung capacity [TLC] 70%, residual volume [RV] 141%). Flexible bronchoscopy revealed normal anatomy and increased secretions at the right lower lobe. Bronchoalveolar lavage was significant for severe inflammation and elevated eosinophils of 22%. At this time, he already self-discontinued minocycline and was prescribed prednisone 20 mg twice a day (0.57 mg/kg per day) with rapid improvement in cough and dyspnea. He required about 5 months of slowly tapering steroids with a post-treatment chest CT revealing resolution of the multiple peripheral consolidations, and pulmonary function tests (PFTs) had normalized.
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