June 2024 Pulmonary Case of the Month: A Pneumo-Colic Association
Pulmonary Department
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
The patient is a 57-year-old woman who presented to the emergency department with increasing cough and shortness of breath over several days. She has a history of ulcerative colitis complicated by toxic megacolon with subsequent colectomy.
Past Medical History, Family History and Social History
Ulcerative colitis with history of toxic megacolon (4 years prior), s/p total colectomy
History of recent respiratory failure thought secondary to ustekinumab (Stelara). The respiratory failure responded well to steroid therapy.
She has a history of latent Tb treated with rifampin
Anxiety
Medications
Clonazepam 1.0 mg daily at bedtime
Gabapentin 300 mg TID
Pantoprazole 40 mg BID
Prednisone 5 mg daily
Physical Examination
Mild-moderate respiratory distress
Afebrile. SpO2 87% on room air. Oxygen saturation 94% on 2 lpm supplemental oxygen.
Chest: crackles noted at left base
Cardiovascular: regular rhythm, no murmur
Extremities: scarring and erythema on both ankles consistent with resolving pyoderma gangrenosum
Laboratory
Hgb 9.7 g/dL
White Blood Cell Count 16.9 × 109/L
Increased neutrophils on differential
Electrolytes, creatinine, BUN and liver function tests within normal limits
Radiology
A portable AP of the chest was performed in the emergency department (Figure 1).
Figure 1. Portable AP of chest done in emergency department.
Which of the following are appropriate next step(s)? (Click on the correct answer to be directed to the second of six pages)
Cite as: Wesselius LJ. June 2024 Pulmonary Case of the Month: A Pneumo-Colic Association. Southwest J Pulm Crit Care Sleep. 2024;28(6):74-77. doi: https://doi.org/10.13175/swjpccs023-24PDF