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

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

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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.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Avnish Sandhu, Pranatharthi Chandrasekar. Dyspnea, Fever, Hemoptysis, and Diabetes in a Tobacco User – Medscape – Dec 02, 2020.

Assistant Professor of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan

Disclosure: Avnish Sandhu, DO, has disclosed no relevant financial relationships.

Professor of Medicine and Chief, Division of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan

Disclosure: Pranatharthi Chandrasekar, MD, has disclosed no relevant financial relationships.

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

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Skin Lesions and Neutropenic Fever in a 69-Year-Old Woman

Skin Lesions and Neutropenic Fever in a 69-Year-Old Woman

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Cameron Nichols, MD; Fnu Nutan, MD

June 26, 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 69-year-old woman presents with neutropenic fever and painful skin lesions. She has a past medical history of myelodysplastic syndrome, neutropenia, chronic obstructive pulmonary disease, and cirrhosis. The skin lesions began 2 weeks prior as small nodules that progressed to painful, red plaques. At that time, they were present on her back, left breast, and right posterior calf.

She also experienced fevers up to 102°F (38.9°C) over the last week. She describes having shortness of breath with myalgias over the last few weeks, in addition to a more recent onset of cough, nausea, and diarrhea. She has no lesions in her mouth or her genitals and reports no vision changes.

Her myelodysplastic syndrome has been treated with azacitidine, which she last received 3 weeks prior. She has a right internal jugular port-a-cath, in which a needle was recently dislodged. She has not had any pain since that time.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Cameron Nichols, Fnu Nutan. Skin Lesions and Neutropenic Fever in a 69-Year-Old Woman – Medscape – Jun 26, 2020.

Resident, Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia

Disclosure: Cameron Nichols, MD, has disclosed no relevant financial relationships.

Assistant Professor, Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia

Disclosure: Fnu Nutan, MD, has disclosed no relevant financial relationships.

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A 5-Year-Old Girl With High Fever and Nonproductive Cough

A 5-Year-Old Girl With High Fever and Nonproductive Cough

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Nicholas J. Bennett, MB BChir, PhD

May 08, 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 normally well 5-year-old girl presents with a 2- to 3-week history of fever, cough, and occasional posttussive emesis. She was seen one week ago and was diagnosed with a viral upper respiratory infection after an unremarkable physical examination. Testing for respiratory viral infections was not performed at that time, and symptomatic care was recommended.

After that visit, the patient improved, and 5 days ago, she was afebrile and well enough to return to school. Two days ago, however, the fever and cough returned worse than before. She is now experiencing pain in her right shoulder. Her mother reports that she “just isn’t herself” and has brought her back for reevaluation.

The patient had one episode of vomiting with coughing 2 days ago, with no diarrhea. She has had decreased appetite and activity when febrile. Her fevers have been as high as 104°F (40°C) at home. Her cough is nonproductive. Her mother has given her acetaminophen two or three times to control the fever, but otherwise she takes no medications.

The patient is a normally healthy child with no significant medical history, and her immunizations are up to date, including a seasonal influenza vaccine last month. She has no siblings and lives with her parents, who do not smoke. No known contact with people exposed to tuberculosis (TB) and no significant travel history are noted.

Upon physical examination, the patient is a slightly ill-appearing young girl in no acute distress. Her temperature is 102.6°F (39.2°C), respiratory rate is 28 breaths/min, heart rate is 152 beats/min, and blood pressure is 103/62 mm Hg. The pulse oximetry reading is 98% while she is breathing room air. Her lungs sound clear bilaterally, with normal percussion and no areas of decreased breath sounds, rales, or wheezing.

The patient has normal heart sounds without any murmur, a soft abdomen without organomegaly, mild cervical adenopathy, and no rashes. Her extremities are warm and well-perfused, with a capillary refill time of 2 seconds. No other lymph nodes are palpable in her axillae or groin.

Because of the recurrent fever and cough, a chest radiograph is obtained (Figure 1), which reveals a right upper-lobe opacification and an area of increased lucency. CT of the chest clarifies the diagnosis (Figures 2 and 3).

Figure 1.

Figure 2.

Figure 3.

Medscape © 2020  WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Nicholas J. Bennett. A 5-Year-Old Girl With High Fever and Nonproductive Cough – Medscape – May 08, 2020.

Staff Physician, Department of Pediatrics, Golisano Children’s Hospital, Upstate Medical University, State University of New York, Syracuse, New York

Disclosure: Nicholas J. Bennett, MB BChir, PhD, has disclosed no relevant financial relationships.

Figure 1.

Figure 2.

Figure 3.

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