Chronic Cough

A 22 years old Chinese gentleman, fresh university graduate with no known medical illness, presented with prolonged productive cough with whitish sputum for 4 weeks and fever for 3 weeks. He also had weight loss of 8 kg in one month time and occasional night sweats. On examination, he appeared lethargic and cachexic with temperature of 37 degrees C. There was reduced chest expansion, presence of stony dullness on percussion, reduced breath sound and vocal resonance over the left lower zone of the lung upon examination of the respiratory system.

Full blood count, renal profile, liver function test were normal. Mantoux test reading was 18 mm and quantiferon TB gold test was positive. Chest X-ray showed left fibrotic lesion on upper zone and pleural effusion of the left lung. Pleural fluid was exudative. Ultrasound of left hemithorax revealed left complex pleural effusion with multiple septations and CECT thorax revealed bilateral upper zone fibrotic changes.

  1. What do you think is responsible for his chronic cough?
  2. What do the respiratory findings in this patient suggest?
  3. What information does a Mantoux test give a doctor about patients with chronic cough?
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