A 52-year-old woman visited a local hospital with a high
fever, non-productive
cough and general
fatigue. Her chest X-ray showed infiltrate in the right middle lung field. Computed tomography scans revealed ground-glass opacity and surrounding ring-shaped air-space consolidation, the "
reversed halo sign". Cefpirom was administered, but her symptoms persisted and the infiltrate migrated to the left upper lobe. As
cryptogenic organizing pneumonia was suspected, she was then treated with intravenously pulsed
methylprednisolone followed by
prednisolone. Despite these
therapies, acute
respiratory failure occurred and she was therefore transferred to our hospital. On admission, severe
hypoxemia and diffuse bilateral infiltrates on chest images suggested
acute respiratory distress syndrome. As we obtained information that a parakeet had recently died at her home,
minocycline was administered, resulting in prompt improvement of the symptoms,
respiratory insufficiency and pulmonary infiltrates. Finally, elevated antibody titers against Chlamydophila psittasi confirmed a diagnosis of
Psittacosis. Sequential chest computed tomography scans in this case indicate that absorption of marginal air-space consolidation with extended central ground glass attenuation in concordance with a new infiltrate on another lung field appeared to create wandering infiltrate. Wandering infiltrate on chest X-ray in
psittacosis may be a sign of
disease progression.