BMJ 2015;351:h3515 doi: 10.1136/bmj.h3515 (Published 16 July 2015)
Page 1 of 4
Endgames
ENDGAMES CASE REVIEW
A case of breathlessness 1
2
Rachelle Shafei core medical trainee , Rowena Goalby trainee general practitioner , John Hutchinson 3 respiratory registrar Department of Medicine, North Middlesex Hospital, London N18 1QX, UK; 2Glasgow, UK; 3Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, UK 1
A 62 year old woman was referred to hospital by her general practitioner because of a few days history of progressive shortness of breath. She had associated fever but no cough or sputum production. Her medical history included rheumatoid arthritis, for which she had been taking methotrexate for the past 12 years.
On examination, she was visibly dyspnoeic, with low oxygen saturations. Her respiratory rate was 22 breaths/min, oxygen saturation was 90% on air, heart rate was 100 beats/min, blood pressure was 115/72 mm Hg, and her temperature was 37.4ºC. Chronic hand changes, consistent with rheumatoid arthritis, were noted. Bilateral widespread crackles were heard on auscultation of the chest. Blood tests showed a white blood cell count of 8.8×109/L (reference range 4-10) and a C reactive protein of 1219 nmol/L (
Page 1 of 4
Endgames
ENDGAMES CASE REVIEW
A case of breathlessness 1
2
Rachelle Shafei core medical trainee , Rowena Goalby trainee general practitioner , John Hutchinson 3 respiratory registrar Department of Medicine, North Middlesex Hospital, London N18 1QX, UK; 2Glasgow, UK; 3Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, UK 1
A 62 year old woman was referred to hospital by her general practitioner because of a few days history of progressive shortness of breath. She had associated fever but no cough or sputum production. Her medical history included rheumatoid arthritis, for which she had been taking methotrexate for the past 12 years.
On examination, she was visibly dyspnoeic, with low oxygen saturations. Her respiratory rate was 22 breaths/min, oxygen saturation was 90% on air, heart rate was 100 beats/min, blood pressure was 115/72 mm Hg, and her temperature was 37.4ºC. Chronic hand changes, consistent with rheumatoid arthritis, were noted. Bilateral widespread crackles were heard on auscultation of the chest. Blood tests showed a white blood cell count of 8.8×109/L (reference range 4-10) and a C reactive protein of 1219 nmol/L (
