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

Abstract

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.