A 56-Year-Old Woman With Worsening Dyspnea and Sarcoidosis

Kennedy O. Omonuwa, MD; Arunabh Talwar, MD; Lindsay Goodman, MD

Disclosures

October 31, 2019

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 56-year-old African-American woman with a 20-year history of pulmonary sarcoidosis presents to the emergency department with a 6-month history of progressive and worsening dyspnea. The patient's dyspnea is worse during exertion and is associated with decreased exercise tolerance. She denies any coughing, wheezing, fever, chest pain, or leg swelling.

She has had multiple presentations to her primary care provider's office; at each visit, the dyspnea was attributed to progression of her underlying pulmonary sarcoidosis, and she was prescribed corticosteroids. Despite steroid therapy, her dyspnea has persisted and has worsened.

The patient's only medications are oral prednisone and multivitamins. She has no known drug or food allergies, as well as no history of smoking, alcohol abuse, or illicit drug use.

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