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4301. A 49-Year-Old Man With Cough and Hand, Wrist, and Knee Pain.
A 49-year-old man was sent by his primary care physician to the rheumatology clinic with complaints of several months of bilateral lower extremity swelling. The swelling migrated from both ankles up to his knees. Presenting symptoms consisted of bilateral knee pain as well as bilateral wrist and hand pain with swelling. Pulmonary symptoms consisted of a nagging productive cough of several months. He also complained of significant weight loss: 50 pounds over 12 months. He was a never smoker. The examination was notable for bilateral knee effusions. Radiographs of his wrists, hands, and knee were obtained, along with a chest radiograph. He was then referred to a pulmonologist for further workup.
4302. A 72-Year-Old Man With a Violaceous Rash and Sepsis.
作者: Ayesha T Gittens.;John-Ross D Clarke.;Shady Abdelbaki.;Jeff S Kwon.
来源: Chest. 2020年157卷2期e41-e45页
A 72-year-old man presented to our ED less than 24 hours following the acute onset of nausea, vomiting, and diarrhea. Within 12 hours of symptom onset, he noted bilateral lower extremity pain and swelling. His pain was associated with a new violaceous irregular rash on the anterior aspect of both feet and legs. There was no history of inciting trauma or recent wounds. In addition, there was no history of consumption of raw or undercooked food (including seafood) or recent change in food source. There was accompanying fever and chills for the same duration and painful swelling of his left thumb. His comorbidities included stage IIIb classical Hodgkin lymphoma diagnosed 4 months prior. His last dose of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy was 4 days before presentation. He had previously failed anti-CD30 monoclonal therapy resulting from attributed pancolitis.
4303. A 50-Year-Old Woman With Confusion and Facial Rash.
A 50-year-old woman presented to the ED with a 3-day history of increasing confusion. Prior to her presentation, the patient had been in her usual state of health as reported by her family. She had a history of bipolar disorder and attention-deficit/hyperactivity disorder but had stopped her psychiatric medications for the past 4 days secondary to loss of insurance coverage. History was limited due to the patient's altered state and confusion, and was obtained from family. There was no history of headache, loss of consciousness, weakness of extremities, seizures, fever, or recent trauma. The patient's medical history also included cocaine abuse. The patient's family believed she had been abstinent from cocaine use for several years.
4304. A 24-Year-Old Man With Recurrent Hemoptysis.
作者: Le Hoan.;Nguyen Ngoc Cuong.;Nguyen Duy Thang.;Dinh Thi Thanh Hong.;Le Minh Hang.;Le Tuan Linh.;Tran Ngoc Minh.;François Pons.;Delphine Natali.
来源: Chest. 2020年157卷2期e31-e35页
A 24-year-old man was admitted for a new episode of hemoptysis. He reported 3 episodes of hemoptysis in the past 2 years. He had no other medical history and was a nonsmoker. As a Vietnamese person born and living in Vietnam, he was at risk for TB, but had not had contact with those having TB in his family or workplace, was never imprisoned nor homeless, and never traveled abroad. He never experienced pneumonia. He coughed up a small amount of fresh with air red blood (around 5 mL each time) several time for 3 days. He had no dyspnea, no chest pain, no fever, no asthenia, and no anorexia.
4305. A 51-Year-Old Woman With Pellets in the Sputum.
作者: Kavitha Venkatnarayan.;Rishabh Raj.;Uma Maheswari Krishnaswamy.;Priya Ramachandran.;Uma Devaraj.;Julian Crasta.;Tabinda Aijaz.
来源: Chest. 2020年157卷2期e25-e29页
A 51-year-old woman with no comorbidities presented with a 3-month history of cough with mucopurulent expectoration and intermittent fever. Over the past 1 month, she complained of streaky hemoptysis and gave history of expectorating "whitish pellets" in the sputum on two occasions. She had developed progressive breathlessness for a week prior to presentation to our hospital. There was no history of chest pain or loss of weight or appetite. She was a nonsmoker and did not consume alcohol. She had received multiple courses of antibiotics at another center with no relief of symptoms.
4306. Vitamin C Deficiency-Induced Pulmonary Arterial Hypertension.
作者: Shameek K Gayen.;Abd A Abdelrahman.;Ioana R Preston.;Raymond D Petit.;Nicholas S Hill.
来源: Chest. 2020年157卷2期e21-e23页
We report a case of a man in his 60s who developed pulmonary arterial hypertension (PAH) in association with profound vitamin C deficiency. Decreased availability of endothelial nitric oxide and activation of the hypoxia-inducible family of transcription factors, both consequences of vitamin C deficiency, are believed to be mechanisms contributing to the pathogenesis of the pulmonary hypertension. The PAH resolved following vitamin C supplementation. The current case highlights the importance of testing for vitamin C deficiency in patients with PAH in the proper clinical setting.
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