Correct!
5. All of the above
At this early stage in the work up, his symptoms could be consistent with an atypical infection, hypersensitivity reaction, idiopathic interstitial pneumonia, Sjogren’s Disease associated pulmonary disease (especially in the setting of a positive SS-A) or mixed connective tissue disease.
Case Continued
He had slight clinical improvement with diuresis, steroids and was discharged home on hospital day 3 on 2-3 liters by nasal cannula. He was referred for pulmonary and rheumatology follow-up and scheduled for a VATS lung biopsy in 5 days.
He returns to the Emergency Department 4 days later complaining of worsening shortness of breath - gasping for breath. He now has an increased oxygen requirement to 5L after exertion and his activity is limited to walking 2 steps. He reports 3 pillow orthopnea and PND sleeping for 1hr, awaking with night sweats, and chills - all unchanged. His dyspnea is very positional and he reports platypnea. He reports an episode of sudden loss of consciousness after ambulating sustaining superficial injury tobridge of nose 2 days before presentation.
Vitals: T: 98.6 BP: 147/83 P: 66 RR: 17 SpO2: 91% 5LNC at rest
Exam essentially unchanged but less peripheral edema
What should be done next in his diagnostic work up? (click on correct answer to move to next panel)