Advertisement

The Many Shades of Dyspnea

Published:September 15, 2017DOI:https://doi.org/10.1016/j.amjmed.2017.08.031
      An 82-year-old woman was readmitted to our hospital in January 2017 with worsening dyspnea on exertion after she was discharged 10 days earlier. Her past medical history included hypertension and hyperlipidemia along with gout, past 30-pack-year smoking history without previously documented chronic obstructive pulmonary disease, coronary artery disease status post 2 drug-eluting stents in 2016 with subsequent ischemic cardiomyopathy (recent ejection fraction 40%), and overt peripheral vascular disease status post right femoral to below the knee popliteal bypass in October 2016, the course of which was complicated by a site wound infection that required treatment with daptomycin and ertapenem. She was recently readmitted in December 2016 secondary to worsening shortness of breath and hypoxia and was found to have volume overload in the setting of heart failure worsening, along with a clinical diagnosis of daptomycin-induced eosinophilic pneumonia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fenves A.Z.
        • Kirkpatrick 3rd, H.M.
        • Patel V.V.
        • Sweetman L.
        • Emmett M.
        Increased anion gap metabolic acidosis as a result of 5-oxoproline (pyroglutamic acid): a role for acetaminophen.
        Clin J Am Soc Nephrol. 2006; 1: 441-447
        • Kortmann W.
        • Van Agtmael M.A.
        • van Diessen J.
        • Kanen B.L.
        • Jakobs C.
        • Nanayakkara P.W.
        5-Oxoproline as a cause of high anion gap metabolic acidosis: an uncommon cause with common risk factors.
        Neth J Med. 2008; 66: 354-357
        • Meister A.
        The γ-glutamyl cycle: diseases associated with specific enzyme deficiencies.
        Ann Intern Med. 1974; 81: 247-253
        • Humphreys B.D.
        • Forman J.P.
        • Zandi-Nejad K.
        • Bazari H.
        • Seifter J.
        • Magee C.C.
        Acetaminophen-induced anion gap metabolic acidosis and 5-oxoprolinuria (pyroglutamic aciduria) acquired in hospital.
        Am J Kidney Dis. 2005; 46: 143-146