Dyspnea, Fever, Hemoptysis, and Diabetes in a Tobacco User

Avnish Sandhu, DO; Pranatharthi Chandrasekar, MD


December 02, 2020

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 60-year-old woman with a history of uncontrolled diabetes, hypertension, and chronic obstructive pulmonary disease (COPD) presents during the winter with progressively worsening shortness of breath over the past 4 days. Associated symptoms include fever, chest pain, runny nose, sore throat, productive cough with hemoptysis, and diarrhea. She says she has not had night sweats, weight loss, or swelling of the lower extremities. About 1 week earlier, her husband also had coldlike symptoms.

The patient has a family history of diabetes and hypertension. She started smoking at age 20 years and smokes one pack of cigarettes per day. She drinks alcohol occasionally and denies any illicit drug use. She has no history of incarceration, homelessness, or recent travel.


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