84-year-old woman with a diagnosis of depression; severe colonic diverticulosis; vertebral crushing D8-D10; vitamin D deficiency; arterial and pulmonary hypertension; atrial flutter and mitral, tricuspid and aortic insufficiency, on treatment with sertraline (50 mg/day v.o.), furosemide (40 mg/day v.o.), furosemide (40 mg/day v.o.), furosemide (40 mg/day v.o.) and furosemide (40 mg/day v.o.). ), furosemide (40 mg/day v.o.), bisoprolol (5 mg/day v.o.), acenocoumarol according to haematology guidelines, omeprazole (20 mg/day v.o.), simvastatin (20 mg/day v.o.), simvastatin (20 mg/day v.o.) and omeprazole (20 mg/day v.o.). ), simvastatin (20 mg/day v.o.), lormetazepam (1 mg/day v.o.), vitamin D (1 ampoule v.o./month), domperidone (10 ml/8 hours v.o.) and home oxygen therapy.
In January 2016, she was admitted to the hospital emergency department for an episode of haematochezia, where she was diagnosed with bilateral pulmonary pathology. A computed axial tomography (CT) scan of the chest revealed extensive bilateral parenchymal pulmonary infiltrates, a calcified granuloma in the middle lobe of the lung and subcarinal lymphadenopathy (15x20 mm). On suspicion of bilateral multi-lobar community-acquired pneumonia, she was prescribed clarithromycin (500 mg/day v.o.) and was discharged from hospital.
In February 2016, the patient was admitted to the internal medicine department for dyspnoea and for the study of pulmonary infiltrates that had not subsided since hospital discharge despite antibiotic treatment. During admission, a Mantoux test and bronchoscopy were performed, both with negative results, in addition to a CT scan showing bilateral airspace condensation, an interlobular adenopathy (15 mm) of possible malignant origin, several irregular nodules and a calcified nodule (6.2 mm).
It was decided to withdraw treatment with sertraline and clarithromycin and the tests were repeated two weeks later, with results showing a decrease in pulmonary infiltrates and less air condensation. The patient experienced both objective and subjective clinical improvement and 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 symptoms.
The patient returned to the emergency department in March 2016 for dyspnoea on slight exertion and oppressive central thoracic pain that increased with deep inspiration. Pulmonary auscultation revealed a vesicular murmur with crackles in the right base.
He was readmitted to internal medicine, where a chest X-ray revealed the presence of smaller pulmonary infiltrates than in the previous admission. It was decided to withdraw sertraline for a second time, and the patient recovered her autonomous capacity, her dyspnoea and chest pain disappeared, and her oxygen saturation increased to 93%.
Two weeks after discontinuation of sertraline treatment, a control chest X-ray was performed, confirming the decrease in the extent of pulmonary infiltrates.
It should be noted that during the whole period the patient had eosinophil levels within the normal range.
The patient's clinical evolution allowed definitive discontinuation of treatment with sertraline, simvastatin, omeprazole, domperidone and vitamin D, maintaining the rest of the medication.