17th February 2025

A 40-year-old gentleman is brought to the Emergency Department by ambulance with moderate volume haemoptysis occurring over the last hour.

A 40-year-old gentleman is brought to the Emergency Department by ambulance with moderate volume haemoptysis occurring over the last hour. He has had decreased appetite, nausea and felt generally unwell for three days. His wife states he has recently been cleaning mouldy hay out of their barn. On examination, he looks severely unwell and has scleral icterus.

Observations are as follows: respiratory rate 32, heart rate 110, temperature 38.3°C. 

Investigations are as follows:

Haemoglobin 125 (130 – 180)

White cell count 18.3 (4 -11)

Platelets 222 (150 – 450)

Mean cell volume 89 (80 – 100)

Sodium 137 (135-145)

Potassium 4.2 (3.5 – 5.5)

Urea 8.2 (2.5 – 7.8)

Creatinine 116 (59 – 104)

Alanine phosphatase 150 (30 – 130)

Alanine aminotransferase 89 (<41)

Aspartate aminotransferase 52 (<45)

Bilirubin 47 (<21)

CRP 213 (<5)

What is the likely diagnosis?