A man with a cavitating lung lesion

A renal inpatient, a man in his 70s, was referred to respiratory medicine with abnormal appearances on chest radiography. His history included haemodialysis for obstructive uropathy and chronic myelomonocytic leukaemia, for which he took hydroxycarbamide. He was otherwise well with no respiratory history. He could usually walk one mile independently. He was a non-smoker and was not taking immunosuppressants. He reported no chest pain, weight loss, or haemoptysis.

He had been a renal inpatient for two weeks for lower limb cellulitis treatment with intravenous teicoplanin. Chest radiography on admission (part of a septic screen) showed no abnormality. During his admission, at 2 kg above his dry weight (post-haemodialysis target weight), he became breathless and a repeat chest radiograph was performed (fig 1), prompting …