A 42-Year-Old Woman With a Chronic Productive Cough

Ashraf Zadshir, MD; Damoun Rezai, MD, MHA; Veronica Venegas; Ashley Dyer


December 14, 2018

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 42-year-old Hispanic woman presented to a primary care clinic over the winter. The patient described fever, chills, intermittent dyspnea, and productive cough during the past week. She also reported a thick, greenish nasal discharge. Her medical history was significant for hypothyroidism, for which she is taking levothyroxine. Her history was also significant for recently diagnosed type 2 diabetes mellitus and hyperlipidemia.

The patient reported heavy alcohol use for several years; a 25–pack-year smoking history; and a history of cocaine, heroin, and methamphetamine use. She stated that she has not used any of those substances for the past 2 years.


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