Cough with sputum

A 70-year-old woman was admitted to our hospital with a 10-year history of productive cough and hypertension, and shortness of breath and reduced activity tolerance for 2 months. This patient, a housewife and non-smoker, was hospitalized several times during the past ten years because of recurrent cough with sputum and opportunistic infections without fever, chest pain, fatigue, night sweats, and weight loss. She had no history of exposure to dust or other contact allergens. She was suspected of chronic bronchitis and intermittently treated with antibiotics with no efficacy for nearly ten years. As her symptoms progressed, shortness of breath and reduced activity tolerance aggravated over the previous two months. 

Examination

All vital signs at presentation were normal (temperature: 37.6 °C, heart rate: 97/min, blood pressure: 155/95 mmHg, saturation: 95%). Clinical physical examination revealed lip purpura and reduced breath sound in the right lung.