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 you would like to suggest for a future Case Challenge, please contact us.
A 50-year-old woman presents due to a persistent cough and dyspnea, despite receiving oral antibiotic therapy for a presumed exacerbation of chronic obstructive pulmonary disease (COPD). She reports moderate sputum production and occasional mild hemoptysis. She denies any recent contact with ill persons or recent travel. She additionally reports frequent and often heavy epistaxis. She denies having fevers, night sweats, or unintentional weight loss. She has not experienced any recent diarrhea, melena, or hematochezia.
In addition to a medical history of seizures, seasonal allergies, hypertension, impaired gastric motility, anxiety, depression, and gastroesophageal reflux disease, she has a longstanding history of COPD, which is normally well-controlled with inhaled fluticasone/salmeterol and albuterol.
The patient's other home medications include ethosuximide, loratadine, verapamil, metoclopramide, promethazine, alprazolam, temazepam, duloxetine, esomeprazole, aminocaproic acid, ferrous sulfate, and a multivitamin. Her surgical history includes a cholecystectomy, knee arthroscopy, and a partial hysterectomy for cervical carcinoma.
The patient's family history does not contribute to this admission, but it is significant in the pathologic process (see Figures 1-3). The patient is a current smoker but does not use any illicit drugs.
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Cite this: Noah Gudel, Alyn Hatter, Stanley L. Fox, et. al. A 50-Year-Old With Telangiectasia, Cough, and Epistaxis - Medscape - Aug 20, 2021.