75 yo F with asthma and new hemoptysis

OBJECTIVES


CASE

75 yo F with a history of asthma presents with subacute progressive dyspnea on exertion and new hemoptysis x 4 days. She first developed productive cough and dyspnea on exertion ~ 1 month ago. She was diagnosed with pneumonia, treated with a course of azithromycin, then returned to care one week ago with fever and worsening SOB. She was diagnosed with “multifocal pneumonia” and treated with levofloxacin.

Her respiratory symptoms continued to worsen and she developed new hemoptysis 4 days ago. She has a history of asthma diagnosed 10 years ago, diet controlled type II diabetes and hypertension. She is on albuterol, fluticasone inhaler, and spironolactone. ROS is notable for ongoing fevers, fatigue, anorexia. She otherwise denies any LE edema, orthopnea.

She is febrile to 38.9C, HR of 95, BPs 130-140s/70s, SaO2 89% on RA.

How would you approach this patient with new hemoptysis? What additional history would be helpful in your evaluation? 


Labs
  • BMP – normal
  • LFTs – albumin of 2.8, otherwise normal
  • CBC – WBC 13.6 (550 eosinophils, 6%), hct 27% (from 36% 1 week prior), plt 589
CXR


What is your differential diagnosis?

What is your next step in management?


DIAGNOSIS AND OUTCOME


TEACHING POINT


TAKE HOME POINTS

ADDITIONAL LEARNING

REFERENCES
  1. Earwood JS & Thompson TD. “Hemoptysis: Evaluation and Management.” AFP. 2015, 91(4):243-249.
  2. Litchenberger III JP, et al. “Diffuse Pulmonary Hemorrhage: Clues to the Diagnosis.” Curr Probl Diagn Radiol, 2014; 43:128-139.