Skill Checkup: A 17-Year-Old Male With Shortness of Breath, Cough With Green Sputum, Headache, and Low-Grade Fever

Enrico Brunetti, MD


November 07, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 17-year-old male patient in Europe presents with shortness of breath, cough with green sputum, and headache. He is having difficulty speaking in full sentences owing to dyspnea. Symptom onset was 8 days ago. The patient has a 9-year history of asthma which progressed to severe 7 years ago and is currently managed with biologic therapy. Having spent so much time indoors during the pandemic, the patient believed that his allergies were bothering him; his asthma symptoms have been made worse with the heavy use of disinfectant in the house.

Over the past few days, the patient has begun to experience difficulty breathing, even when resting. The patient was vaccinated for coronavirus disease 19 (COVID-19) 10 months ago but has not received a booster shot. Pulmonary auscultation is significant for diffuse sibilant rales on anterior and posterior of the lungs. Body temperature is 37.2°C (99°F), heart rate is 110 per minute, respiratory rate is 38 per minute, and oxygen saturation is 88%. Initial leukocyte, lymphocyte, eosinophil, and platelet counts are slightly decreased. Aspartate transaminase and alanine transaminase levels are elevated. Serum immunoglobulins are high. Polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were detected positive by nasopharyngeal swabs.


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