A 56-year-old man presented to the ED after 4 days of hemoptysis and intermittent left chest pain that worsened when he was supine. Ibuprofen provided some relief. He also felt tired and complained of exertional dyspnea. Joint pain, primarily affecting the knees, shoulders, and elbows also had bothered him for the past few months. His temperature was normal; he had no chills and had not lost any weight. He said he had been treated for “pneumonia” twice during the past month. Past medical and surgical histories were unremarkable. He was a social drinker and did not smoke cigarettes.
Figure 1. Arrows indicate bilateral infiltrates.
The patient was pale and had small telangiectasias on his face. He had mild tenderness over the knees and shoulders. Active and passive range of motion measures were normal. Results of blood chemistry tests were: sodium, 135 mEq/L; potassium, 5.3 mEq/L; chloride, 107 mEq/L; bicarbonate, 15 mEq/L; BUN, 91 mg/dL; creatinine, 7.9 mg/dL; glucose, 81 mg/dL. The hemoglobin level was 8.4 g/dL; white blood cell (WBC) count, 10.9 x 103/μL; platelets, 234 x 103/μL. Urinalysis revealed large amounts of blood, and 82 red blood cells (RBCs) per high-power field. Chest films revealed bilateral infiltrates (Figure 1).
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