A 56-Year-Old Man With Emphysema, Rash, and Arthralgia.

Abstract

CASE PRESENTATION:

A 56-year-old man presented to the pulmonary clinic with dyspnea and hypoxemia on exertion. He was an avid biker and skier who had noticed a significant decrease in high-level physical activity over the past 3 years. He reported dyspnea, desaturations at altitudes higher than 9,000 feet, dry cough, tachycardia, and palpitations with exercise. Review of systems was also notable for gluten-intolerance, Raynaud's phenomenon, recurrent skin lesions and joint swelling, pain, and stiffness in the areas overlying the jaw, wrists, knees, and ankles (after capsaicin exposure). He denied fever, chills, anorexia, weight loss, hair loss, ocular symptoms, jaw claudication, chest pain, or lower extremity swelling. He had a five pack-year smoking history, no history of prematurity, childhood asthma, recurrent infections, or environmental and occupational exposure. Based on pulmonary function tests from an outside provider, he had received a diagnosis of exercise-induced asthma and had been prescribed an albuterol inhaler to use on an as-needed basis, which failed to improve his symptoms. He was later prescribed a mometasone-formoterol inhaler, still with no symptomatic improvement.

• Authors: Khushboo Goel, Mehrnaz Maleki-Fischbach, M Patricia George, Darlene Kim, John Richards, Robert A Wise, Karina A Serban
• Journal: Chest (Chest) Vol. 160 Issue 5 Pg. e513-e518 (11 2021) ISSN: 1931-3543 [Electronic] United States
• PMID: 34743855 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Chemical References

• Autoantibodies
• Bronchodilator Agents
• Complement C4
• Immunologic Factors
• Rituximab
• Complement C1q
• Prednisolone

Topics

• Arthralgia (diagnosis, etiology)
• Autoantibodies (blood)
• Bronchodilator Agents (administration & dosage)
• Complement C1q (analysis, immunology)
• Complement C4 (analysis)
• Diagnosis, Differential
• Emphysema (diagnosis, etiology)
• Exanthema (diagnosis, etiology)
• Humans
• Immunologic Factors (administration & dosage)
• Male
• Middle Aged
• Patient Care Management (methods)
• Prednisolone (administration & dosage)
• Pulmonary Arterial Hypertension (diagnosis, etiology)
• Rituximab (administration & dosage)
• Vasculitis, Leukocytoclastic, Cutaneous (blood, diagnosis, physiopathology)