CASE FOR DIAGNOSIS Cough, fatigue and fever

A 37-yr-old male complained of a dry cough, fever, nocturnal sudation and dyspnoea. On lung auscultation, his general practitioner noticed right-sided expiratory wheezing and the diagnosis of tracheitis was withheld. Clarithromycin and a cough syrup were given and a slight amelioration was noticed, except for the persistence of dry cough. Bronchial hyperreactivity was suspected and a combination of budeso-nide and formoterol was added to the treatment. During the following 2 months, symptomatology varied; cough and dyspnoea were intermittently present until the patient started complaining of right thoracic pain and important fatigue. Fever re-appeared reaching 39uC, and, after consulting his general practitioner, cefuroxime and paracetamol were prescribed. Once again the fever disappeared, but a very invalidatin