June 2017 Critical Care Case of the Month

Stephanie Fountain, MD

Pulmonary and Critical Care Medicine

Banner University Medical Center Phoenix

Phoenix, AZ USA

History of Present Illness

The patient is a 60-year-old woman who presented with a month long history of of odynophagia with retrosternal pain and occasional nausea and vomiting.

Past Medical History, Social History and Family History

She has a past medical history of mixed connective tissue disease with anti-phosopholipid antibody. There is also a history of leukocytoclastic vasculitis, chronic leg ulcers, and poor dentition. She also has a history of chronic obstructive lung disease (COPD) and is a current smoker having accumulated about 50 pack-years of cigarette smoking.

Current Medications

• Prednisone 20 mg daily
• Azathioprine 75 mg daily
• Plaquenil 400 mg daily
• Salmeterol/fluticasone BID
• Albuterol prn

Electrocardiographic, Radiologic and Laboratory Evaluation

Her electrocardiogram and chest x-ray were unremarkable. Complete blood count showed a white blood cell count of 10,500 cells per microliter (mcL), hemoglobin 10.3 grams/deciliter (dL), hematocrit 31%, and platelet count of 48,000 cells per mcL. Electrolytes were unremarkable and creatinine was 0.6 mg/dL.

What should be done next? (Click on the correct answer to proceed to the second of six pages)

1. Bronchoscopy
2. Gastroenterology consult
3. Platelet and red blood cell (RBC) transfusion
4. 1 and 3
5. All of the above

Cite as: Fountain S. June 2017 critical care case of the month. Southwest J Pulm Crit Care. 2017;14(6):262-8. doi: https://doi.org/10.13175/swjpcc061-17 PDF