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A 56-Year-Old Man With Chronic Cough, Hemoptysis, and a Left Lower Lobe Infiltrate

  • Alexandra Miller
    Affiliations
    Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
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  • Janelle Wenstrup
    Affiliations
    Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
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  • Sanja Antic
    Affiliations
    Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
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  • Chirayu Shah
    Affiliations
    Vanderbilt University Medical Center Department of Radiology and Radiological Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN
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  • Robert J. Lentz
    Affiliations
    Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Thoracic Surgery, Vanderbilt-Ingram Cancer Center, Nashville, TN
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  • Parker Panovec
    Affiliations
    Faith Family Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
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  • Pierre P. Massion
    Correspondence
    CORRESPONDENCE TO: Pierre P. Massion, MD, Division of Allergy, Pulmonary and Critical Care Medicine, Cancer Early Detection and Prevention Initiative, Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, Preston Research, Nashville, TN 37232
    Affiliations
    Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Vanderbilt University Medical Center Department of Radiology and Radiological Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN

    Cancer Early Detection and Prevention Initiative, Vanderbilt-Ingram Cancer Center, Nashville, TN
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      Case Presentation

      A 56-year-old man presented to the lung nodule clinic with abnormal chest imaging prompted by a chronic cough and hemoptysis. Approximately 2.5 years earlier, while kneeling beside his car fixing a flat tire, he fell backwards while holding the tire cap in his mouth, causing him to inhale sharply and aspirate the cap. He immediately developed an intractable cough productive of flecks of blood. He presented to an emergency room but left before being seen because of a long wait time and his lack of health-care insurance. He self-medicated for severe cough and chest discomfort with codeine, eventually developing a dependency. Approximately 3 weeks after aspirating the tire cap, his cough became productive, and he developed fever and chills. His symptoms improved transiently with antibiotics and additional narcotics. Ultimately, his chronic cough with intermittent hemoptysis affected his ability to work, and 30 months later he sought medical attention and was diagnosed with pneumonia and reactive airway disease. He was prescribed doxycycline, steroids, inhaled albuterol, and dextromethorphan, with initial improvement, but his symptoms recurred multiple times despite quitting smoking, leading to repeated medication courses.
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