哮喘联盟

   摘要
   一位66岁女性患者表现为急性发热，畏寒，并产生与右侧胸部疼痛相关的咳嗽。在最近一次因呼吸困难住院期间，她被诊断为抗人球蛋白阳性的自身免疫性溶血性贫血，并于入院前约6周开始服用强的松，并逐渐减量服用。在这期间，类固醇治疗已解决她的呼吸困难问题。在此次就诊时，她服用的强的松剂量为40mg。患者的其他病史包括静脉血栓栓塞症（VTE）和类固醇导致的糖尿病，因VTE正在接受抗凝治疗。很多年前，她已经在她的祖国接受结核病治疗。该患者8年前从一个尼泊尔村庄移民到纽约皇后区。在尼泊尔时，她曾在一个农场工作并与奶牛有过接触史。在皇后区时，她和她的家人住在一起，房子有一个小花园但没有养宠物。最近的行程包括9个月前访问尼泊尔和就诊前一个月去过一趟纽约州锡拉丘兹旅游。这位患者没有烟、酒史。
 

（苏欣 审校）
Chest. 2015 Apr 1;147(4):e140-7. doi: 10.1378/chest.14-1858.
 

A 66-year-old woman with Fever, cough, and a tongue lesion.
 

Gandhi V, Singh A, Woods GL, Epelbaum O.
 

Abstract
A 66-year-old woman presented with acute onset of fever, chills, and productive cough associated with right-sided chest pain. During a recent hospitalization for dyspnea, she had been diagnosed with Coombs-positive autoimmune hemolytic anemia and had been taking a tapering dose of prednisone starting approximately 6 weeks prior to admission. In the interim, her dyspnea had resolved on treatment with steroids. At the time of presentation, her prednisone dose was 40 mg. Additional medical history included VTE, for which the patient was receiving anticoagulation therapy, and steroid-induced diabetes mellitus. Many years earlier, she had been treated for TB in her home country. The patient had immigrated to Queens, New York, from a Nepalese village 8 years prior. While still in Nepal, she had worked on a farm and had been in close proximity to cows. In Queens, she lived with her family in a house with a small garden but had no pets. Recent travel included a visit to Nepal 9 months ago and a trip to Syracuse, New York, one month prior to presentation. She was a never smoker and did not consume alcohol.
 

Chest. 2015 Apr 1;147(4):e140-7. doi: 10.1378/chest.14-1858.