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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 41-Year-Old Woman With Severe Dyspnea and Painful Oral Mucosal Ulcerations

Brenda L. Rice, MD; Laleh A. Bedocs, DO; Hina Sahi, MD, FCCP
Author and Funding Information

From the Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute (Drs Rice and Sahi), and the Dermatology and Plastic Surgery Institute (Dr Bedocs), Cleveland Clinic, Cleveland OH.

Correspondence to: Hina Sahi, MD, Cleveland Clinic, Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, A90, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: sahih@ccf.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1236-1239. doi:10.1378/chest.09-2143
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Extract

A 41-year-old woman with a 19 pack-year smoking history presented to her physician with a 2-month history of progressively worsening dyspnea. Pulmonary function testing revealed a severe obstructive ventilatory defect and air trapping with an FEV1 of 0.53 L (18% of predicted) and a residual volume of 4.09 L (254% of predicted). CT chest scan showed diffuse bilateral bronchiectasis and air trapping (Fig 1). She initially received a diagnosis of severe asthma and was started on high-dose oral steroids. Two months later she experienced painful ulcers on her tongue and oral mucosa as well as dry eyes, blurred vision, associated conjunctivitis, and a 20-pound weight loss over 2 months. Stevens-Johnson syndrome was suspected; however, punch biopsy from the mandibular labial mucosa revealed herpes simplex virus. She was treated with acyclovir for recalcitrant herpes stomatitis with minimal improvement.

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