Reversed Halo Sign on Chest Computed Tomography in a 33-Year-Old Man Without Immunosuppression

      A 33-year-old man presented to the emergency department (ED) with fatigue, lack of appetite, abdominal pain, and arthralgia for 14 days. He had already consulted his general practitioner 10 days previously, who suspected a diverticulitis and initiated antibiotic treatment with ciprofloxacin and metronidazole. Because his symptoms did not improve, a computed tomography (CT) scan of the abdomen was performed, which was unremarkable. However, as pulmonary infiltrates were evident in the basal lungs, the patient was referred to the ED for further evaluation. He had an unremarkable medical history and was not on any regular medication. He was a nonsmoker, drank alcohol occasionally, and worked as an IT specialist. On further questioning, he reported recurrent epistaxis 6 weeks ago and an unremarkable examination by an ear-nose-throat (ENT) specialist at this time.
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