September 2012 Pulmonary Case of the Month: The War on Drugs

Sudheer Penupolu, MD

Philip J. Lyng, MD

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

History of Present Illness

A 69 year old woman was seen with a three day history of nonproductive cough and shortness of breath.

PMH, SH and FH

She has a past history of atrial fibrillation and hypothyroidism.

Her present medications include:

• Diltiazem
• Amiodarone
• Aspirin
• Levothyroxine
• Multi vitamins

There is a 20 pack-year smoking history but she quit in 1998. She is employed as a law school professor.

Physical Examination

Her physical examination is normal.

Chest X-ray

Her admission chest x-ray is shown in Figure 1.

An electrocardiogram showed normal sinus rhythm.

Which of the following is the most likely cause of the patient’s clinical picture?

1. Viral bronchitis
2. Exacerbation of COPD
3. Pneumonia
4. Congestive heart failure
5. Drug reaction

Reference as: Penupolu S, Lyng PJ, Wesselius LJ. September 2012 pulmonary case of the month: the war on drugs. Southwest J Pulm Crit Care 2012;5:107-14. (Click here for a PDF version of the article)