Acute Dyspnea and Hemoptysis in an 84-Year-Old Man With Multiple Comorbidities

• Published in: Chest Vol. 161; no. 2; pp. e97 - e101
• Main Authors: Bueno-Sacristán, Diego, Pintado, Beatriz, Durán-Barata, Diego, Navarro-Cantero, Antonia, Mirambeaux, Rosa Mariela, Palacios, José, Barrios, Deisy, Benito, Amparo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022
• Subjects: Aged, 80 and over; Biopsy - methods; Bronchoalveolar Lavage - methods; Bronchoscopy - methods; COVID-19 - diagnosis; COVID-19 - epidemiology; Diagnosis, Differential; Ferrous Compounds - administration & dosage; Ferrous Compounds - adverse effects; Hematinics - administration & dosage; Hematinics - adverse effects; Hemoptysis - diagnosis; Hemoptysis - etiology; Humans; Lung Diseases - chemically induced; Lung Diseases - diagnostic imaging; Lung Diseases - physiopathology; Lung Diseases - therapy; Male; Multiple Chronic Conditions - therapy; Respiratory Aspiration - complications; Respiratory Aspiration - diagnosis; Respiratory Aspiration - physiopathology; SARS-CoV-2; Tomography, X-Ray Computed - methods; Withholding Treatment
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2021.09.011

An 84-year-old man with an active smoking habit presented to the ED with dyspnea, hemoptysis, and thick phlegm that was difficult to clear. He reported no weight loss, no fever, and no chest pain or dysphonia. He denied both international travel and previous contact with confirmed cases of TB or SARS-CoV-2. He had no known occupational exposures. The patient’s personal history included a resolved complete atrioventricular block that required a permanent pacemaker, moderate-to-severe COPD, rheumatoid arthritis (treated with oral prednisone, 2.5 mg/d) and B-chronic lymphocytic leukemia (treated with methotrexate and prophylactic oral supplements of ferrous sulfate). Moreover, he was in medical follow up because of a peptic ulcer, atrophic gastritis, and colonic diverticulosis. The patient also had a history of thoracic surgery after an episode of acute mediastinitis from an odontogenic infection, which required ICU management and temporal tracheostomy.