Dyspnea and Night Sweats in a 46-Year-Old Man

Roza Chaireti, MD; Mats Pettersson, MD

Disclosures

January 15, 2020

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background and Physical Examination

A 46-year-old man presents to the emergency department with a 5-day history of progressively worsening breathlessness on exertion and mild, general flulike symptoms. He also complains about night sweats and an intermittent low-grade fever, both of which started about 2 weeks ago.

Upon physical examination, the patient does not appear to be in any acute distress. His vital signs are measured as a pulse of 89 beats/min, blood pressure of 140/85 mm Hg, and a respiratory rate of 19 breaths/min. He is afebrile, with a temperature of 99.8°F (37.7°C).

The chest examination reveals nothing out of the ordinary, and his cardiovascular and respiratory examinations, including auscultation, are unremarkable. The abdominal examination reveals no fluid thrill, shifting dullness, or bruit. The liver and the spleen are not enlarged. No lymph nodes are palpable.

Multiple areas of hyperpigmentation are noted; otherwise, the skin inspection is unremarkable, with no hematomas, bruises, wounds, or scars noted. Electrocardiography (ECG) reveals a sinus rhythm with a heart rate of 84 beats/min, and the T waves are somewhat flattened in leads V1, aVL, and III, but they are otherwise unremarkable.

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