Clinical Information

Case Study: 56-year-old Caucasian male police officer has had mild but progressive exertional dyspnea after walking two flights of stairs. This condition has persisted for the past month. Dyspnea became worse today, prompting emergency room evaluation.

CLINICAL INFORMATION

History

• 56-year-old Caucasian male police officer has had mild but progressive exertional dyspnea after walking two flights of stairs. Symptom has been evident for the past month. Dyspnea became worse today, prompting emergency room evaluation
• Seen for 102ºF fever 2 weeks prior. Given clarithromycin followed by levofloxacin 1 week later when not improved. Fever is now gone
• Past medical history: OSA (on CPAP), COPD
• Current medications: tiotropium, fluticasone/salmeterol 250/50, levofloxacin
• Habits: 2 packs of cigarettes daily between the age of 16 to 50, quit 6 years ago (48 pack years)
• Allergies: None known
• No unusual hobbies or pets
• Review of systems negative for arthritis, chills, weight loss, or sputum production

Physical Exam and Work-up

• PE: Temp 99ºF, patient in mild respiratory distress with RR of 24/min. SpO₂ 86% on room air
• No rash or clubbing noted
• Chest exam: basilar velcro-type crackles on auscultation
• The remainder of the examination is normal

Tests

• WBC = 7.6 with 82% PMN, 9% Mono, 8% Lymph, 1% Eosinophil
• An arterial blood gas on room air is performed showing 7.47/34/43
• To exclude pulmonary embolism, a CXR and contrasted thin section CT scan is performed