A 47-Year-Old With Progressive Dyspnea and Weepy Nodules

Dora E. Izaguirre, MD; Jesus Lanza, MD

Disclosures

November 19, 2021

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

A 47-year-old man with no history of significant illness presents to his primary care physician with progressive dyspnea over the past two years. According to the patient, his dyspnea worsens with exertion. He has an associated intermittent productive cough with yellowish sputum that has responded to a short course of antibiotics in the past. No associated chest pain, hemoptysis, fever, night sweats, or weight loss is reported.

Upon initial presentation to his primary care physician at the time of symptom onset, the patient was prescribed albuterol for possible asthma, which resulted in mild improvement of his symptoms. His shortness of breath has recently gotten worse, to the point that he is limited to light activities around the house; he previously played golf on the weekends. His family history includes other members with similar symptoms and "liver problems." He previously smoked one pack of cigarettes a week for the past 10 years but quit six months ago. He does not drink alcohol in excess and does not use illicit drugs. He does not take any medications or vitamin supplements.

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