David J. Riedel, MD

A 51-year-old man with a long history of alcohol abuse and heavy cigarette smoking presented to our hospital with worsening of a chronic cough, which had become productive of thick green sputum and was associated with posttussive emesis. He denied fevers and chills but had a recent and unintentional weight loss of about 5 kg. He had a history of squamous cell carcinoma of the right tonsil, which remained in remission for more than 4 years after chemotherapy, radiation therapy, and resection. There was no recent history of travel or any occupational exposures or known contacts with tuberculosis or animals (wild or domestic).