An Unusual Diagnosis Presenting as SOB and Pleural Effusions

​BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; &ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave way to more significant pedal edema at the end of the day and progressively worsening exertional dyspnea. He noted a low grade fever and loss of appetite. His initial vitals were a blood pressure of 185/96 mm Hg, a heart rate of 106 bpm, a respiratory rate of 20 bpm, a temperature of 100.1°F, and oxygen saturation of 97% on room air.The patient appeared well, but would not stop sipping water despite obvious myxedema. He also had a history of autoimmune and oncological conditions.The differential for this case included an infectious process such as viral or bacterial infiltrate. Lung mass or atypical presentation of myeloma with the patient's history of MGUS was also on the differential, but cardiorenal disease, nephrotic disease, and congestive heart failure were higher on the list. Other etiologies were considered, including thyroid disease, syndrome of i...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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