Pulmonary
The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing and more. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
December 2021 Pulmonary Case of the Month: Interstitial Lung Disease with Red Knuckles
Department of Pulmonary Medicine
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
A 56-year-old man was referred for a second opinion on recent onset of diffuse parenchymal lung disease. He had started noting mild dyspnea with yard work approximately in March 2021. His symptoms progressed over the next month with increasing shortness of breath and some fever. He presented to outside emergency department on April 17, 2021 and chest CT showing patchy ground-glass opacities with some areas of irregular consolidation (Figure 1).
Figure 1. Representative images from the thoracic CT in lung windows from outside emergency room visit.
He was subsequently seen by an outside pulmonologist and started empirically on prednisone (50 mg/day). An outside lung biopsy had been performed which showed nonspecific interstitial pneumonitis. There was some improvement in his symptoms and his prednisone dose was reduced to 20 mg/day; however, his symptoms subsequently worsened with saturations noted to drop to 85% with any ambulation. He also had swelling of his left face and a biopsy of the parotid gland with the findings suggestive of malignancy, possibly melanoma.
What should be done at this time? (Click on the correct answer to be directed to the second of seven pages)
- History and physical examination
- Repeat the open lung biopsy
- Repeat the parotid biopsy
- 1 and 3
- All of the above