An unusual but important cause of wheezing

A 42-year-old Ecuadorian male presented with nocturnal wheezing, cough and purulent sputum. The symptoms had started approximately 4 months previously. After travelling to Venezuela, the patient had visited a general practitioner reporting flu-like symptoms which resolved with symptomatic medication. Soon afterwards, the patient developed dyspnoea with low-grade fever and eventually productive cough. The patient denied having had any other symptoms at that time. The patient was treated for community-acquired pneumonia with clarithromycin, acetylcysteine and bronchodilators. The symptoms improved, but nocturnal wheezing without dyspnoea and cough with purulent sputum had been bothering the patient intermittently during the previous 2 months. The cough was especially disturbing at awakening and at night. The patient self-referred to a pneumologist.