July 2021 Critical Care Case of the Month: When a Chronic Disease Becomes Acute

Kara Calhoun MD, MPH

Division of Pulmonary Sciences & Critical Care Medicine

University of Colorado

Denver, CO USA

History of Present Illness

A 32-year-old woman with no known past medical history presented with progressive shortness of breath for the past 2 weeks. She denied having a cough, fever, or chills, but she did have a one-month history of fatigue, weakness, and painful rashes on her hands.

PMH, SH, and FH

• No known past medical history
• Former tobacco user (quit 2 years prior to admission)
• No drug use
• Worked as an office assistant
• Has two pet dogs and four pet macaws
• No family history of lung disease
• Not taking any prescription medications

Physical Exam

• BP: 116/65, Pulse: 105, T: 37°C, RR: 28, SpO2: 89% on HHFNC (60L; 100%)
• Pulmonary: Tachypneic, in respiratory distress, crackles throughout
• Cardiovascular: Tachycardic but regular, no murmurs
• Extremities: No edema
• Skin: Palms with purplish discoloration and erythematous papules

Radiography

Figure 1. Initial portable chest x-ray.

Which of the following should be done next?

1. CT Chest
2. COVID-19 testing
3. Sputum gram stain and culture
4. 1 and 3
5. All of the above

Cite as: Calhoun K. July 2021 Critical Care Case of the Month: When a Chronic Disease Becomes Acute. Southwest J Pulm Crit Care. 2021;23(1):1-4. doi: https://doi.org/10.13175/swjpcc023-21 PDF