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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 59-Year-Old Man With Shock, Polycythemia, and an Underlying Paraproteinemia*

Karolien Dams, MD; Wouter Meersseman, MD; Eric Verbeken, MD, PhD; Daniel C. Knockaert, MD, PhD
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*From the Department of General Internal Medicine (Drs. Dams and Knockaert), the Medical Intensive Care Unit (Dr. Meersseman), and the Department of Pathology (Dr. Verbeken), University Hospital of Leuven, Leuven, Belgium.

Correspondence to: W. Meersseman, MD, Department of General Internal Medicine, University Hospital of Leuven, Herestraat 49, B-3000 Leuven, Belgium; e-mail: wouter.meersseman@uz.kuleuven.ac.be



Chest. 2007;132(4):1393-1396. doi:10.1378/chest.07-0456
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A 59-year-old man presented to the emergency department with a 1-day history of a flu-like syndrome with nausea, vertigo, thirst, low-grade fever, and myalgias. His medical history was remarkable for arterial hypertension and a follow-up for a monoclonal gammopathy of undetermined significance (MGUS [IgG type λ]). He had experienced a non-ST-elevated myocardial infarction 2 months prior to hospital admission for which he had undergone a percutaneous angioplasty with stenting of the circumflex coronary artery. His recovery was uneventful. He received therapy with perindopril, 2 mg/d; simvastatin, 40 mg/d; bisoprolol, 5 mg/d; aspirin; clopidogrel; molsidomine; and ezetimibe. He had smoked for 40 years. Family and exposure histories were noncontributory. There was no known history of allergy.

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