Case 34-1998

Presentation of Case A 71-year-old woman was admitted to the hospital because of fever, dyspnea, and hypotension. Her history included an inferior myocardial infarction 19 years earlier; hypertension; renal insufficiency ascribed to chronic pyelonephritis, with a creatinine level ranging from 1.8 to 2.2 mg per deciliter (159.1 to 194.5 μmol per liter); a left nephrectomy; and chronic paranoid schizophrenia. There was a mass in the right middle lobe and a calcified right hilar lymph node, both of which had remained unchanged on periodic radiographic assessment for seven years. Twelve weeks before the current admission, the patient was admitted to the . . .