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Postgraduate Education Corner |

A 58-Year-Old Man With Episodically Widened Pulse Pressure*

Adam Ronan, MD; Gregory A. Schmidt, MD, FCCP; Stephanie Justin, MD; Kirk T. Spencer, MD
Author and Funding Information

*From the Department of Medicine (Drs. Ronan, Spencer, and Justin), University of Chicago, Chicago, IL; and Division of Pulmonary Diseases, Critical Care, and Occupational Medicine (Dr. Schmidt), University of Iowa, Iowa City, IA.

Correspondence to: Gregory A. Schmidt, MD, FCCP, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, 200 Hawkins Dr, C33-GH, Iowa City, IA 52242; e-mail: gregory-a-schmidt@uiowa.edu


Chest. 2007;131(1):313-316. doi:10.1378/chest.06-0679
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A 58-year-old man was admitted to the hospital with fevers, weakness, and dyspnea for 2 days. His medical history was significant for end-stage renal disease (dialysis three times weekly via arteriovenous [AV] graft), coronary artery disease status after myocardial infarction and stenting of a left anterior descending artery lesion 4 years prior, and ischemic cardiomyopathy with class III congestive heart failure. One year prior to this hospital admission, septic phlebitis and bacterial endocarditis related to an implanted cardioverter-defibrillator were treated with device removal, replacement of both aortic and mitral valves (St. Jude mechanical prostheses), prolonged antibiotic therapy, and long-term anticoagulation. Five days prior to hospital admission, a superficial skin abscess of the anterior chest wall was drained. He remained well until 48 h before presentation when dyspnea, weakness, and diffuse myalgias rapidly developed. He was febrile at a hemodialysis session, blood cultures were subsequently positive for methicillin-resistant Staphylococcus aureus (MRSA), and he was admitted.

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