Mulch pneumonitis in a patient with chronic granulomatous disease.

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Date: Nov. 15, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 44)
Publisher: CMA Impact Inc.
Document Type: Clinical report
Length: 521 words
Lexile Measure: 1350L

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A 44-year-old man with a history of chronic granulomatous disease presented to the emergency department with a 1-day history of fever and shortness of breath. Physical examination showed only tachycardia and tachypnea, with lungs clear to auscultation. Chest radiograph showed diffuse, ill-defined micronodular opacities (Figure 1). The patient was treated with amoxicillin-clavulanic acid for presumed community-acquired pneumonia. He returned 5 days later with persistent fever, progressive dyspnea and hypoxia. Repeat chest radiograph showed substantial progression with new coarse interstitial infiltrates and ground glass opacities (Appendix 1, available at www. The patient reported that the day before his symptom onset, he had been feeding hay to large animals at a livestock farm in rural Ontario.

We considered the following diagnoses: acute fungal (aspergillosis, histoplasmosis, blastomycosis) and bacterial (Q fever, nocardiosis)...

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Gale Document Number: GALE|A726460705