Antibiotic-Resistant Cough and Back Pain in a 63-Year-Old

Winston W. Tan, MD; Matthew Tan

Disclosures

October 16, 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

A 63-year-old woman presents with a chronic cough. She was in her usual state of health until 3 months ago, when she developed a dry cough with fever. She was initially treated with antibiotics for 2 weeks. The cough improved, and the fever resolved. However, the dry cough returned.

The patient reports recent several instances of hemoptysis, as well as a 5-lb weight loss that she attributes to her recent diet change and exercise. She also describes chest pain, shortness of breath, dyspnea, and significant lower back pain.

Her medical history is significant for hypertension and diabetes. Her family history includes a father who had congestive heart failure at age 73 years. The patient gets her eyes checked regularly. She has never seen a pulmonary specialist. She reports aches and pains that vary, depending on how much physical activity she gets. She has had a hysterectomy. She is married and denies smoking, although she reports a history of continued secondhand smoke exposure.

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