CASE STUDY:
59-Year-Old Male With 3 Weeks of Increasing Dyspnea

CLINICAL INFORMATION

HISTORY OF PRESENT ILLNESS

A 59-year-old Caucasian male with a history of idiopathic pulmonary fibrosis (IPF) presented in the winter of 2004 with 3 weeks of increasing shortness of breath. His IPF was diagnosed approximately 1 ½ years earlier when a video-assisted thorascopic lung biopsy showed usual interstitial pneumonia (UIP).

He originally presented with a dry cough, dating to the winter of 2000 and was seen by his primary care physician who prescribed antibiotics for a "pneumonia" identified on chest radiograph. His cough persisted, despite this course of treatment, and by the winter of 2001, he developed dyspnea on exertion, which prompted a full cardiac work-up, including a reportedly normal cardiac catheterization. In the spring of 2002, the patient underwent a high-resolution computed tomography (HRCT) scan and a nondiagnostic bronchoscopy, which ultimately led to a lung biopsy.

Following his diagnosis, the patient started on interferon gamma in the fall of 2002 and did well without significant functional limitations and continued working full time for just over 1 year until he presented with this most recent episode of increasing shortness of breath. He was admitted to the hospital in mild respiratory distress for further evaluation.

PAST MEDICAL HISTORY

The patient's past medical history is unremarkable except for his IPF and gastroesophageal reflux disease (GERD), which is well controlled with a proton-pump inhibitor.

SOCIAL HISTORY

The patient was employed as a full-time teacher throughout his adult life and had no significant environmental or occupational exposures. He quit smoking 30 years ago after consuming 1 pack/day for 12 years. He denied the use of alcohol or illicit drugs.

FAMILY HISTORY

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