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Clinical Problem-Solving
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Volume 346:1813-1816 June 6, 2002 Number 23
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Diagnosis Still in Question
Ashish K. Jha, M.D., Harold R. Collard, M.D., and Lawrence M. Tierney, M.D.

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A 59-year-old banker was referred for the evaluation of fevers that had started three weeks earlier, shortly after his arrival in western Texas on business. The fevers were associated with dyspnea on exertion. A physician prescribed an inhaled beta-agonist and clarithromycin, which had no effect. The patient's fevers worsened, as did the dyspnea on exertion. A nonproductive cough, a sore throat, a nonpruritic erythematous rash over his trunk, and right-sided pleurisy developed. Another physician prescribed levofloxacin.

Many diagnoses might explain these symptoms. Coccidioidomycosis is endemic in some parts of far western Texas. Exertional dyspnea can occur with this disorder and . . . [Full Text of this Article]

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From the General Internal Medicine Section, Veterans Affairs Medical Center (A.K.J.), and the Department of Medicine, University of California, San Francisco (A.K.J., H.R.C., L.M.T.) — both in San Francisco.

Address reprint requests to Dr. Jha at the General Internal Medicine Section (111), Veterans Affairs Medical Center, 4150 Clement St., San Francisco, CA 94121, or at ashish@itsa.ucsf.edu.

References


Related Letters:

Diagnosis Still in Question
Musher D. M., Young E. J., Jha A. K., Collard H. R., Tierney L. M. Jr.
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N Engl J Med 2002; 347:1805-1806, Nov 28, 2002. Correspondence

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