Fever and dyspnoea in a tracheostomised patient

A 65-year-old man was referred for evaluation of acute onset of fever, productive cough and dyspnoea. He had previously received a diagnosis of laryngeal carcinoma, which had been treated with laryngectomy and bilateral laterocervical lymphadenectomy, followed by chemotherapy. He underwent plastic surgery of the laryngocutaneous fistula, and a positron emission tomography (PET)- computed tomography (CT) examination performed during follow-up showed 18-FDG (2-fluoro-2-deoxyd- glucose) lung uptake in the apical right portion. He had a smoking history and his regular medications included dexamethasone, metoclopramide, omeprazole, furosemide, cholecalciferol and pregabalin. He had a history of chronic kidney failure and thyroid goitre, no family history of pulmonary disease or malignancy, nor of drug allergies.