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Cough, dyspnoea and purulent sputum in a 66-yr-old nonsmoking female.

Case history A 66-yr-old female presented with dyspnoea on exercise, severe cough, purulent sputum and intermittent chest pain under both costal arches for the last 14 days. Five months prior to admission, pulmonary tuberculosis of both lower lobes had been diagnosed microscopically as the cause of recurrent bilateral pleural and pericardial effusions and pericardial thickening, and the patient was still under a two-drug antituberculous regimen. Loss of weight and fever were denied. She was a nonsmoker. Physical examination revealed wheeze over the left lower chest. The chest radiograph on admission was normal except for pleural thickening at the left lower chest wall associated with a small pleural effusion. Pulmonary function tests showed the following results: total lung capacity (TLC) 4.5 L (70% pred), forced expiratory volume in one second (FEV1) 1.3 L (45% pred), forced vital capacity (FVC) 2.2 L (59% pred), peak expiratory flow (PEF) 51%, maximal expiratory flow when 75% of the FVC remains to be exhaled (MEF75%) 36% pred; FEV1/FVC 83% pred,