SOB in mctd patient (follow-up 7/17)

Home / Journal Club / SOB in mctd patient (follow-up 7/17)

A 50s F with htn, a rheum disorder (?mctd, being worked up) cc sob.  The sob has been for three days, and is largely dyspnea on exertion.  There is no chest pain, orthopnea, pnd, or leg swelling.  She has a dry cough x 3 days and feels generally weak.  About a week ago, she had a zoster outbreak on her R chest wall for which she is finishing a week’s valtrex.  Her meds include plaquenil and low-dose prednisone.  She has no allergies.

On exam, HR 114, RR 20, BP 122/84, T 98.9.  Her RA O2 sat is 93.  She appears well and not sob at all.  Her lungs are clear, heart sounds are normal.  There is no s3 or jvd, there is no edema or tenderness on her legs.  On her R chest wall, she has well-healed zoster lesions.  When she gets up and walks around, she is moderately dyspneic.

This is her cxr.  An ekg is normal (not tachycardic anymore).

What is the dx / ddx?
How shall we treat the patient?
Where do we dispo the patient?
What is likely needed as an inpatient?


Leave a Reply