A 65-year-old Black man presents to his doctor reporting of cough, dyspnea, wheezing, and occasional hemoptysis for the past 3 months. He had a bout of pneumonia 1 month ago that did not require hospitalization. He also reports feeling very tired almost constantly.
Physical exam reveals dullness to percussion on the back and decreased, asymmetric breath sounds on the right side, and presence of both stridor and wheezing. Fist percussion of the spine reveals nothing remarkable, and there are no focal neurologic deficits. However, there is evidence of tender hepatomegaly as well as lymphadenopathy in the cervical nodes.
Laboratory testing reveals nothing remarkable in these areas: complete blood count with differential, thyroid panel (including normal serum parathyroid hormone levels), serum electrolytes, and magnesium. Calcium levels reveal hypercalcemia (13.0 mg/dL) and liver function tests are elevated (aspartate aminotransferase = 50 U/L, alanine transaminase = 150 U/L, blood urea nitrogen = 35 mg/dL).
The patient has a negative history for cancer of any kind but has hypertension and hyperlipidemia, both of which are pharmacologically well managed. He is a pack-a-day smoker for the past 45 years. He worked in construction for 40 years and retired 3 years ago at age 62 years.
