Reviewed By Critical Care Assembly
Submitted by
Timothy R. Watkins, MD
Acting Instructor of Medicine
Division of Pulmonary and Critical Care Medicine
University of Washington, Harborview Medical Center
Seattle, WA
Colin R. Cooke, MD, MSc
Senior Fellow
Division of Pulmonary and Critical Care Medicine
University of Washington, Harborview Medical Center
Seattle, WA
Submit your comments to the author(s).
History
A 67-year-old man who was recently diagnosed with pulmonary tuberculosis and treated with four-drug antituberculous directly observed therapy for the last month presented to the emergency department with hemoptysis. The patient stated he had small amounts of blood-streaked sputum for the past 2 weeks, but noted that immediately prior to coming to the emergency department he had coughed up approximately “a cup” of bright red blood. While still in the emergency department, he had a witnessed episode of large volume hemoptysis, estimated to be greater than 250 cc of fresh blood.
The patient’s past medical history was unremarkable with the exception of longstanding tobacco abuse. Other than his recent antituberculous therapy he took no regular medications. He did not regularly use aspirin or other NSAIDs. He had no history of rash, kidney disease, hematuria, or known autoimmune disease. Prior to the episodes described above, he had no history of pneumonia or hemoptysis.
The patient smoked one pack of cigarettes per day for the past 45 years. He did not use alcohol or other recreational drugs. He emigrated from Ethiopia to the United States 10 years earlier. The patient was single, living with his brother’s family. He worked as a carpenter until 2 to 3 months earlier when he became ill.
Physical Exam
Lab
Hematocrit 12%
Platelet count was 378,000/mm3
BUN 49 mg/dl, serum creatinine was 1.1 mg/dl
Alkaline phosphatase 124mg/dl
Total bilirubin 1.4mg/dl
AST 50 IU/L, ALT 29 IU/L
The patient’s electrolytes and serum glucose were within normal limits.
An INR and PTT were within normal limits.
A urinalysis showed an elevated specific gravity and the presence of hyaline casts.
Figures
References
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