A 55-year-old Panamanian man was referred from a penitentiary clinic to Hospital Santo Tomas in March, 2014. He presented with a 10-day history of breathing difficulty, chest pain, fever, headache, and had also lost more than 10 kg in weight over the previous 2 months. His medical and family history was unremarkable; however, he reported that he had been in contact with inmates who had had chronic cough for 2 years. The patient's vital signs were normal, apart from a respiratory rate of 28 breaths per min. Physical examination showed wasting and diminished breath sounds at the basal area of the right luiag and pleural friction rub. Neurological examination showed normal mental status and sensory findings, normal reflexes, and negative meningeal signs.
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