A 68-year-old man presented with the chief complaint of progressive dyspnea on exertion.
At baseline, the patient had been able to walk without limitation for more than 6
city blocks. Over the course of 3 to 4 weeks, his dyspnea increased to the point where
he could not ambulate from his bedroom to his bathroom without resting. He had no
chest pain, loss of consciousness, leg pain, or wheezing. His past history was significant
for hypertension, tophaceous gout, and coronary artery disease. In 2003, renal cell
carcinoma metastatic to the right chest wall was discovered, 15 years after the original
diagnosis. The patient had refused treatment for the recent malignancy. His medications
on admission included aspirin, 81 mg daily, metoprolol, 25 mg bid, methyldopa, 500
mg tid, furosemide, 20 mg daily, and colchicine, 300 mcg daily. At one time, the patient
smoked 40 packs of cigarettes a year, but he had quit 10 years earlier. He was a retired
employee of The Johns Hopkins Hospital and had no known toxic exposures.
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Article info
Footnotes
☆Requests for reprints should be addressed to Charles M. Wiener, MD, Department of Medicine, Johns Hopkins School of Medicine, 1830 East Monument Street, Suite 9030, Baltimore, Maryland.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
