Episode Details

We’re back with another edition of Fellows’ Case Files! Today, we’re virtually visiting Rutgers University, Robert Wood Johnson Medical School to work through a fascinating pulmonary case. Enjoy, and let us know your thoughts.

Meet Our Guests

Khalil El Gharib completed his residency training at Northwell at Staten Island University Hospital Program and is currently a first year fellow at Rutgers Robert Wood Johnson Medical School.

Sabiha Hussain completed her residency training at Robert Wood Johnson Medical School and her fellowship training at Columbia Presbyterian Medical Center in New York. She is currently a Professor of Medicine and the fellowship Program Director.

Case Presentation

• Patient: 28-year-old male with Asperger’s syndrome and IgA nephropathy.
• Symptoms: 3-month history of progressive dry cough and dyspnea on exertion; later developed mild hemoptysis.
• Notable exposure: Questionable black mold in the patient’s apartment.

Initial Workup and Diagnostic Reasoning

• Vital signs: Hypoxemia (SpO₂ 91% on room air).
• Exam: Inspiratory crackles.
• ABG findings: Elevated A–a gradient (~50), indicating a gas exchange problem.
• Chest X-ray: Bilateral, patchy infiltrates without specific lobar preference.
• Initial management: Discharged with empiric antibiotics for presumed multifocal pneumonia.

Re-Presentation and Further Testing

• Symptoms worsened; now with blood-tinged sputum.
• Chest CT: Showed diffuse ground-glass opacities (GGOs) without fibrosis, consolidation, or lymphadenopathy.

Imaging and Pathology