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Fevers, weight loss, and bilateral peripheral infiltrates in a young man.

(CHEST 1999; 115:1181‐1183) A 28-year-old man with a remote history of snorting cocaine presented with a 3-month history of fevers, nightsweats, weight loss, and cough. Similar symptoms had occurred 1.5 years earlier. At that time, the appearance of the chest radiograph (Fig 1), borderline peripheral eosinophilia (total eosinophil count of 300/mm 3 ), and negative sputum and blood cultures prompted the diagnosis of chronic eosinophilic pneumonia (CEP). The symptoms and lung opacities markedly improved within 2 weeks of initiating prednisone treatment at 60 mg qd. Three months later, the patient stopped taking steroids and was lost to follow-up. He denied using illicit drugs between presentations. Physical Examination The patient’s temperature was 36.8°C, pulse was 84 beats/min, BP was 148/94, and respirations were 28 breaths/min. The patient was well-appearing and had a nonproductive cough. There were raised violaceous lesions on his left shoulder and forehead. The chest was clear, the heart had an increased P2 component, and there was a 1.5 3 1.5-cm right submandibular lymph node.