Southwest Journal of Pulmonary, Critical Care and Sleep

Kashif Yaqub, MD

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

History of Present Illness

A 61-year-old man was admitted to the hospital with cough, dyspnea and hypoxemia. He had some prior respiratory symptoms about a month prior to admission, but his symptoms worsened recently. He was seen in Family Medicine Clinic on the day of admission and noted to have saturations of 88 – 89%.

A thoracic CT scan was done shortly after his initial symptoms but was negative for lung consolidation or pulmonary embolus. He currently was having fever with temperatures of 99 to 103 degrees and cough that was only slightly productive.

PMH, FH, SH

He had a history of hypertension and obstructive sleep apnea although he was not using continuous positive airway pressure (CPAP).

Medications

nifedipine
lisinopril/hydrochlorothiazide
cough medication

Physical Examination

General: SpO2 95% on 2l/min by nasal cannula

Chest: his breath sounds were coarse, but there were no wheezes or crackles.

Cardiovascular: regular rate and rhythm with no murmur noted

Extremities: no clubbing, cyanosis or edema.

Skin: no rashes noted.

Laboratory

CBC: Hemoglobin 15.1 d/dL, WBC 15.3 x 10³cells/µL, no eosinophilia.

Procalcitonin: 0.22 ng/mL (normal < 0.15 ng/mL).

Nasopharyngeal swab: PCR negative for pertussis, chlamydophila and mycoplasma pneumonia.

Radiography

His thoracic CT scan at the initial presentation of his illness about a month prior to admission was reviewed (Figure 1).

Figure 1. Representative images from thoracic CT scan in lung windows done about one month prior to admission.

Which of the following are appropriate at this time? (Click on the correct answer to proceed to the next panel)

Reference as: Yaqub K, Wesselius LJ. December 2014 pulmonary case of the month: bronchiolitis in adults. Southwest J Pulm Crit Care. 2014;9(6):297-301. doi: http://dx.doi.org/10.13175/swjpcc149-14 PDF