A 50-Year-Old With Telangiectasia, Cough, and Epistaxis

Noah Gudel, DO; Alyn Hatter, DO, MS; Stanley L. Fox, MD; Marilyn W. Edmunds, PhD, CRNP

Disclosures

August 20, 2021

Physical Examination and Workup

The physical examination reveals a 50-year-old woman in no acute distress. Her oral temperature is 99.4°F (37.4°C). Her pulse is 80 beats/min, and her blood pressure is 111/63 mm Hg. A pulse oximetry examination reveals a room air saturation of 97%. Examination of the lungs shows bilateral rhonchi and mild wheezing. Examination of the cardiovascular system is unremarkable, as is the abdominal examination. Examination of the skin is remarkable for the pathologic process revealed in the images seen in Figures 1-3. She is also noted to have multiple superficial nonbleeding vessels on the nasal septum.

Figure 1.

Figure 2.

Figure 3.

Portable chest x-ray is obtained and does not reveal any effusions or infiltrates. A complete blood cell count shows an increased white blood cell count of 15.6 x 103/µL (15.6 x 109/L; reference range: 4.4-11.3 x 103/µL), as well as a microcytic, hypochromic anemia (with a hemoglobin of 9.2 g/dL [92 g/L], a mean corpuscular volume of 76 μ/m3 [76 fL], and a mean corpuscular hemoglobin of 21.6 pg/cell).

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