Out of breath

A woman experiences persistent breathlessness, cough and chills that won't resolve with antibiotic treatment.

Alison, a 25-year-old non-smoking paediatric nurse, presented to her GP with productive cough (without haemoptysis), breathlessness on minimal exertion and night sweats.

Of Cambodian origin but born and raised in Australia, Alison had travelled to Vietnam and Cambodia 12 months ago.

She does not recall exposure to patients with tuberculosis and denies exposure to birds. Alison's past medical history is unremarkable and she does not take any regular medications. 

After initial empirical treatment with amoxycillin/clavulanic acid (Augmentin Duo Forte) and doxycycline for four weeks, a repeat chest X-ray showed a left lower lobe abnormality without other significant changes (see figure 1 below).

Figure 1: Chest X-ray. Left lower lobe