Case 30-1964

Presentation of Case A fifty-six-year-old man entered the hospital because of seizures. Fifteen years previously exertional dyspnea and a cough productive of sputum developed, and x-ray films of the chest revealed pulmonary fibrosis; his occupation was changed to that of a mechanic after twenty-seven years as a pipe fitter. Three years before admission a routine film of the chest (Fig. 1) showed persistence of the changes in the lungs. Two years later methylprednisolone therapy was begun and was continued for eleven months. Two weeks before admission the patient entered another hospital for evaluation and while there had a seizure characterized . . .