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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

Fever and Dyspnea in a 61-Year-Old Woman With Metastatic Breast Cancer

Rawad El Ghoul, MD; Shea M. Eckardt, MD, PT; Sanjay Mukhopadhyay, MD; Rendell W. Ashton, MD, FCCP
Author and Funding Information

From the Departments of Medicine (Dr. El Ghoul and Eckardt) and Pathology (Dr. Mukhopadhyay), State University of New York Upstate Medical University, Syracuse, NY; and Respiratory Institute (Dr. Ashton), Cleveland Clinic Foundation, Cleveland, OH.

Rendell W. Ashton, MD, FCCP, 9500 Euclid Ave, A90, Cleveland, OH 44195; e-mail: ashtonr@ccf.org


The work for this article was performed at the State University of New York Upstate Medical University.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(2):634-638. doi:10.1378/chest.08-2962
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Extract

A 61-year-old woman presented to her oncologist complaining of a 3-day history of fever, chills, fatigue, anorexia, and mild shortness of breath without cough or chest pain. She had recently received a diagnosis of invasive ductal carcinoma of the breast with liver metastases. She had completed her third cycle of palliative chemotherapy 3 weeks prior to presentation. Her chemotherapy regimen consisted of doxorubicin, cyclophosphamide, pegfilgrastim, dexamethasone (10 mg IV), and lorazepam. She also received oral dexamethasone, 4 mg twice daily for 3 days, after every cycle for nausea. Her medical history included hypertension, and she had recently quit smoking (40 pack-year smoking history). She denied contacts with sick persons, pets, travel, or history of malignancy among parents or siblings. She was admitted to the hospital and treated for community-acquired pneumonia without improvement. After 3 days, she required transfer to the ICU for worsening hypoxemia with persistent fever and leukocytosis.

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