Case: 62-year-old male with progressive shortness of breath over the past two years

Chief Complaint:
62-year-old man with progressive shortness of breath over the past 2 years

History of Present Illness:
Two years before his pulmonary evaluation patient began having shortness of breath (SOB) while hiking at 8,000’ elevation. The SOB had become progressively worse in the past 12 months. A month prior to presentation, while hiking at elevation, he developed severe SOB requiring admission to a local hospital with initial differential diagnosis of high altitude pulmonary edema versus pneumonia.

On discharge, he was dependent on supplemental oxygen and was referred to a pulmonologist. His pulmonologist noted the patient’s history of classic Raynaud’s phenomenon associated with new onset GERD over the prior two years.

The patient reported no exposures related to hypersensitivity pneumonitis including birds, mold, down comforters; he was exposed to hot tubs. His only chemical exposure was to malathion he sprayed in his backyard garden.