Abstract
We present the case of an 80-year-old woman who had a 12-month history of progressive exertional dyspnoea, nonproductive cough, generalised weakness, and weight loss. Of note, she had worked until her fifties in many different jobs including 15 years of farming, managing paddy fields and vegetable farms, followed by five years in a wood factory. She was admitted to our hospital in September 2014 with a dense ischaemic stroke. Her medical history included hypertension and ischaemic heart disease. She had multiple admissions to different cardiology units in other hospitals with the symptoms described above. She was treated for congestive cardiac failure, after which, standard treatment of frusemide failed to improve her symptoms. On examination, she was alert, afebrile, tachypnoiec with a respiratory rate of 28 breaths/minute, blood pressure of 135/ 75 mmHg and oxygen saturation of 88% by pulse oximetry on room air. Pulmonary auscultation revealed course crepitations bibasally up to the level of midzones of both lung fields. She did not have the usual signs of heart failure such as raised jugular venous pressure and peripheral oedema. She had dysphasia and complete paralysis of her right side in keeping with her stroke. Her chest radiograph revealed bilateral diffuse lung fibrosis (Fig. 1a) and high resolution computed tomography (HRCT) (Fig. 1b–d) revealed dense fibrosis as well as traction bronchiolectasis at right upper lobe and both lower lobes, whereas the right middle lobe and left upper lobe showed reticulonodular opacities and ground-glass changes.
Published Version
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