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July 1996

Cutaneous Lesions Provide a Clue to Mysterious Pulmonary Process

Author Affiliations

Case Western Reserve University, Cleveland, Ohio

Arch Dermatol. 1996;132(7):823-824. doi:10.1001/archderm.1996.03890310109019

REPORT OF A CASE  A 36-year-old white man from the Ohio River Basin Area presented to a pulmonologist with a 2-month history of a nonproductive cough, external dyspnea, generalized fatigue, anorexia, and a 13.6-kg weight loss. He denied any recent travel, and he had no pets or unusual hobbies. He worked as a security guard for an apartment complex. He denied intravenous drug use, homosexuality, or blood transfusions before 1987. His medical history was unremarkable. The patient's initial physical examination revealed a thin, mildly disheveled white man in no apparent distress. His vital signs were within normal limits except for a mild tachycardia (heart rate, 100 beats per minute). He had a few scattered crackles in his lower lung fields, with good breath sounds. No lymphadenopathy was present. His white blood cell count was 12.1 ×109/L, and his enzyme-linked immunosorbent assay was negative for human im

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