Palpitations, Cough in a Woman Who Lives Next to a Zookeeper

Dora Izaguirre-Anariba, MD, MPH, CHES; Hung-I Liao, MD; Jesus C. Lanza, MD


October 05, 2022

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.


A 43-year-old woman with obesity has a medical history that includes multiple respiratory infections, dyspepsia, hypertension, and breathing problems during childhood presents to her primary care physician. She reports dyspnea over the past several years, beginning prior to the COVID pandemic, that is exacerbated by changes in weather. Her dyspnea is accompanied by heart palpitations and chest tightness. She also complains of an intermittent productive cough with yellowish sputum that has responded to short courses of antibiotics in the past.

She has visited the emergency department on more than 10 occasions during the last 6 months, with an admission to the intensive care unit (ICU), where she was treated with noninvasive ventilatory support. She is currently negative for COVID-19.

She smoked as much as a pack of cigarettes per day before quitting 3 months ago. Although she has lived in the same neighborhood for the last 20 years, she recalls that a zookeeper has just moved into the apartment next door and keeps birds on his window. She acknowledges that she has not been compliant with her home medications, despite counseling given by her doctor. She also describes being embarrassed because her partner does not want to sleep in the same room due to her heavy snoring. Today, she feels more short of breath and anxious than on previous visits.