This is the case of a 55-year-old African American female, with past medical history of hypertension and illicit drug use, who presented with worsening productive cough. The patient stated that the cough had been ongoing for the past 5 months but had worsened in severity over the last 2 weeks prior to admission. She complained of associated fever and chills for two days, sore throat, and copious white sputum. She denied shortness of breath, wheezing, and pleuritic chest pain. She also denied having hemoptysis. Patient denied having had any recent exposure to sick individuals. She is a 40-pack-year smoker, drinks alcohol socially, and admits drug use.
Upon admission temperature was 98.1 F, blood pressure 112/61, heart rate 92 beats per minute, respiratory rate 18 breaths per minute, and saturation 99% in room air. Physical examination was significant for left lower lobe rhonchi without wheezing or rales. Laboratory studies were significant for elevated leukocyte count of 13.0 x 103/muL with a negative procalcitonin level. All other laboratory values were within normal limits. Urine drug screen was positive for opiates.
Chest X-ray revealed left-sided infiltrative pattern (Figures 1(a) and 1(b)). A CT scan of the chest (Figures 2(a) and 2(b)) showed left-sided pneumonia involving the lingula and posterior basal segment and endobronchial occlusion of the posterior segment of the left lower lobe, possibly foreign body, not present on prior chest X-ray. Patient is subsequently scheduled for bronchoscopy.
Prior to bronchoscopy, the patient disclosed additional information about her social history. She stated that 5 months prior to the admission, she was abusing cocaine and during an altercation with law enforcement she attempted to ingest a vial of cocaine. Bronchoscopy was performed, which revealed a significant circumferential inflammation of the left lower lobe segment and a foreign body noted in the postbasal left lower lobe bronchus. The foreign body was successfully removed with biopsy forceps, revealing a synthetic vial measuring 3.2 x 0.7 x 0.7 cm (Figure 3).
Following bronchoscopy, the patient's cough improved significantly. She denied having shortness of breath, wheezing, and fever. Patient was sent home with oral antibiotics along with her home medications.