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 66-year-old man presents to his primary care physician with a 12-month history of progressive dyspnea and nonproductive cough. Six months earlier, his respiratory symptoms worsened after he had COVID-19; he received no treatment and was not hospitalized. He has a past medical history of hypertension and hyperlipidemia, for which he takes hydrochlorothiazide and atorvastatin, respectively. His surgical history is significant for an appendectomy 10 years ago.
Chest radiography performed in the office of his primary care physician is unremarkable, and he receives a diagnosis of bronchitis. He is treated with a short course of doxycycline and prednisone, and a regimen is started of scheduled inhaled corticosteroids and albuterol to use as needed. The patient returns in 3 months without significant improvement in his symptoms and is referred to the cardiology service. A stress test and an echocardiogram are unremarkable. He returns 3 months later with ongoing symptoms and is referred to the pulmonology service. A rheumatologic review of systems is positive for occasional acid reflux and hand joint pain.
The patient is a former smoker (he quit smoking 10 years ago) with a history of more than 30 pack-years. He reports no alcohol or illicit drug use. He drives a soda delivery truck and has no environmental exposures either at work or at home. His family history is notable for his father's death from "pulmonary fibrosis."
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Cite this: A Truck Driver With Progressive Dyspnea and Cough - Medscape - Jul 14, 2023.