Female patient, 84 years old, diagnosed with dementia, with severe choledocholithiasis (1; vertebral compression D8-D10; deficiency of vitamin D-8; chronic obstructive pulmonary hypertension and chronic obstructive pulmonary disease (20 mg), vomethoprim/fur.
In January 2016 he came to the hospital emergency department for an episode of hematochezia, where he was diagnosed with bilateral lung disease.
A chest computed tomography (CT) revealed the presence of large bilateral parenchymal pulmonary infiltrates, a granuloma calcified in the pulmonary middle lobe and a subcarinal lymphadenopathy (15x20 mm).
The suspected bilateral multilobular pneumonia acquired in the community was treated with clarithromycin (500 mg/day) and was discharged.
In February 2016, the patient was admitted to the internal medicine service due to dyspnea and to the study of pulmonary infiltrates that had not been diagnosed since hospital discharge despite antibiotic treatment.
During admission, the Mantoux test and bronchoscopy were performed, both with negative results, in addition to a CAT scan that reflected condensation of the bilateral air space, an interlobular adenopathy (15 mm) of possible malign origin.
It was decided to withdraw the treatment with sertraline and clarithromycin, and the tests were repeated two weeks later, obtaining results that showed a decrease in pulmonary infiltrates and lower air condensation.
The patient experienced both objective and subjective clinical improvement, so she was discharged from the hospital.
Five days after discharge, the patient restarted treatment with sertraline on the advice of her primary care physician in the event of a possible recurrence of the depressive disorder.
The patient came to the emergency room again in March 2016 due to dyspnea on mild exertion and oppressive chest pain, which increased with deep inspiration.
Median pulmonary auscultation revealed vesicular murmur with crackles on the right base.
The patient was readmitted to internal medicine, where a chest X-ray revealed the presence of smaller pulmonary infiltrates than on the previous admission.
It was decided to withdraw sertraline for the second time, with which the patient recovers her autonomous capacity, dyspnea and chest pain disappeared, increasing oxygen saturation to 93%.
After two weeks of discontinuation of sertraline, a control chest X-ray was performed confirming a decrease in the extent of pulmonary infiltrates.
It should be noted that throughout the period the patient had eosinophil levels within the normal range.
The clinical evolution of the patient allowed permanent discontinuation of sertraline, simvastatin, methotrexate and vitamin D, maintaining the rest of the medication.
