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A patient with persistent wheezing, sinusitis, elevated IgE, and eosinophilia

1999; Elsevier BV; Volume: 82; Issue: 2 Linguagem: Inglês

10.1016/s1081-1206(10)62588-4

1534-4436

Jeff Robinson, Zulfiqar Ahmed, Afzal A. Siddiqui, Thomas Roy, Steven L. Berk, John Kelly Smith, Guha Krishnaswamy,

Allergic Rhinitis and Sensitization

HISTORY OF PRESENTING ILLNESS A 76-year-old Caucasian male, with a past medical history of severe steroiddependent asthma, presented with a 4-day history of worsening shortness of breath and a productive cough. His medical records documented four admissions to the hospital in the last few months for similar complaints. In spite of aggressive therapy for his asthma, including triamcinalone, albuterol, and ipratropium inhalers plus oral prednisone (20 mg daily), his dyspnea worsened progressively. He was now using nebulized albuterol every few hours, with minimal relief. The patient also had symptoms compatible with persistent rhinosinusitis but denied fever, chills, sweats, or recent infectious contacts. He had no symptoms of orthopnea, postural nocturnal dyspnea, or hemoptysis. The patient also denied epistaxis, arthritis, unusual skin eruptions, hematuria, or abdominal pain. There was no history of recent travel. His other routine long-term medications were nitroglycerin, 0.2 mg transdermal patch daily; Adalat, CC 30 mg PO daily; enteric-coated aspirin, 325 mg PO daily; cimetidine, 800 mg PO twice daily; lorazepam, 1 mg PO twice daily; and calcium carbonate 500 mg PO daily.