A Woman Who Owns a Hot Tub and Chickens Has Dyspnea, Cough

Nadia Sweet, MD; Maria Daniela Martin, MD; Tiffany Lin, MD


September 22, 2022

Physical Examination and Workup

Upon physical examination, the patient appears healthy and in no acute distress. Her blood pressure is 126/84 mm Hg, with a heart rate of 65 beats/min. Her respiration rate is 20 breaths/min, and her oxygen saturation is 99% on room air. She is afebrile, with a temperature of 98.6 °F (37 °C). Her body mass index is 29 kg/m2.

No scleral icterus is noted. Her nasal passages are clear, with mild erythema. Ear canals are patent, and tympanic membranes appear normal. Her posterior oropharynx is clear. No cervical or supraclavicular lymphadenopathy or jugular venous distention is noted. The chest examination reveals slightly distant breath sounds toward the bases; otherwise, the lungs are clear bilaterally. The heart rate and rhythm are regular, and no murmurs are detected. Results of the abdominal examination are benign, with no hepatosplenomegaly. She has no active synovitis, joint deviation, calcinosis, sclerodactyly, or mechanic's hands. Examination of the skin reveals no rashes or rheumatoid subcutaneous nodules.

A complete blood cell count with differential, comprehensive metabolic panel results, and levels of thyroid-stimulating hormone and inflammatory markers are all normal.

CT of the chest reveals right middle lobe and lingular bronchiectasis, bronchial wall thickening, and multiple predominantly solid airway centered nodules in the areas of bronchiectasis and in other lobes (Figure 1). Bronchoscopy with bronchoalveolar lavage shows no bacterial culture growth, negative results for 1,3-beta-d-glucan and galactomannan, and a negative ThinPrep test for malignancy.

Figure 1.


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