CASE STUDY:
50-Year-Old Male with Dyspnea and Raynaud Phenomenon

CLINICAL INFORMATION

HISTORY OF PRESENT ILLNESS

A 50 year-old Caucasian male presented with three months of progressive dyspnea that followed an episode of purulent bronchitis. He would become short of breath after climbing one flight of stairs. He noted the presence of a mild yet persistent dry cough but was more concerned with his dyspnea. The patient denied the presence of joint pain, skin lesions, myalgias, or systemic symptoms like fever, fatigue, or generalized malaise.

PAST MEDICAL HISTORY

The patient's past medical history was unremarkable except for a recent episode of Raynaud phenomenon. He denied any history of coagulopathy or deep vein thrombosis (DVT). He was taking no medications associated with interstitial lung disease and had no drug allergies.

SOCIAL HISTORY

The patient had a remote history of smoking (3 packyears). He denied any occupational exposures or bird exposures.

FAMILY HISTORY

The patient denied the presence of any interstitial lung diseases or connective tissue diseases in his immediate family members.

PHYSICAL EXAMINATION

On examination, the patient was a pleasant male appearing his stated age and in no acute distress. His vital signs are listed below:

Examination of his head and neck was unremarkable. Auscultation of his chest revealed diminished expansion of his chest bilaterally with bibasilar and axillary crackles. His heart had a regular rate and rhythm without murmurs, rubs, or gallops, and his abdomen was benign. Examination of his extremities revealed mild bilateral swelling of his fingers with a few maculopapular lesions over the dorsum of his right fingers. He did have periungual erythema but no telangiectasias, calcinosis, sclerodactyly, or skin thickening. There was no clubbing of the extremities.