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Internal Medicine

Public·45 members

A 72 y/o male with a PMH of gout and hyperlipidemia presents to the clinic for chronic persistent cough, dyspnea on exertion and a 50 lb weight loss over the past 4 months.


His cough is mostly dry and reports no recent URTIs/LRTIs. He also complains of night sweats for the past few weeks. He denies having any fevers, headache, blurry vision, chills, N/V, chest pain, palpitations, hemoptysis, orthopnea, diarrhea, constipation, urgency urination or other medical complaints, and has no recent travel history. He has been a professional boxer throughout his life. He stopped training 2 months ago because of his cough and dyspnea.


VSS

Patient appears fatigued and weak. Physical examination is unremarkable.

He is currently not taking any medications.

Smoking history: 20 pack years

He denies consuming alcohol or other drugs.

Family history is unremarkable.


Labs:

WBC 21.1

RBC 4.7

Hb 11.1

MCV 75

Platelets 621

ESR 100

HbA1c 6.2

Cr 0.93

Na 134

K 4.9

Cl 99

HCO3 27

Iron 30 (Low)

Ferritin 654 (High)

TSH 3.2

Rheumatoid Factor 127 (normal: < 14)

Anti CCP, Centromere, SS-A, SS-B, Scl 70, dsDNA antibodies: Negative

HIV Ag/Ab: non reactive


CT thorax attached below.


What are your most likely diagnosis and differentials?


Mazen Kherallah
N G
S U
Ayesha Khan

Thank you @Nader Guma please provide a follow up on the work up that was done and update us once the diagnosis is established

To se mi líbí
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