Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Division of Pulmonary and Critical Care, Department of Internal Medicine, Veterans Affairs Ann Arbor Health System, Ann Arbor, MI.
Chest. 2020 Dec;158(6):e279-e282. doi: 10.1016/j.chest.2020.07.002.
A 35-year-old veteran presented at our clinic with insidious dyspnea on exertion, nonspecific chest pain, and intermittent rash. The patient reported the development of dyspnea over 6 to 8 weeks. He had been physically active before this time but had since developed dyspnea after walking 30 to 61 m (100 to 200 ft) or with any more strenuous physical exertion. He described a nonproductive cough, with bilateral nonspecific chest pain that was worse with exertion. In addition, there was a fleeting, salmon-colored, nonpruritic rash over the bilateral arms and legs that was not responsive to over-the-counter topical steroids. The patient's medical history was notable for a 15-pack-year smoking history, posttraumatic stress disorder, depression, Clostridium difficile colitis, migraines, and alcohol abuse. Surgical history was notable for pyloric myotomy for stenosis and umbilical hernia repair. He lived with his partner and five children and was unemployed at the time because of dyspnea. There were no pets in the home and no prior occupational exposures, including silica, heavy metals, or birds.
一位 35 岁的退伍军人因进行性劳力性呼吸困难、非特异性胸痛和间歇性皮疹到我们的诊所就诊。患者报告在 6 至 8 周内出现呼吸困难。在此之前，他的身体一直很活跃，但此后在行走 30 至 61 米（100 至 200 英尺）或进行更剧烈的体力活动后，就会出现呼吸困难。他描述了一种非生产性咳嗽，伴有双侧非特异性胸痛，活动后加重。此外，双侧手臂和腿部出现短暂的、鲑鱼色、非瘙痒性皮疹，对外用类固醇无反应。患者的病史包括 15 包年的吸烟史、创伤后应激障碍、抑郁、艰难梭菌结肠炎、偏头痛和酗酒。手术史包括幽门肌切开术治疗狭窄和脐疝修复。他和他的伴侣以及五个孩子住在一起，由于呼吸困难而失业。家中没有宠物，也没有职业暴露史，包括硅石、重金属或鸟类。
