Short of Breath and Teary-Eyed

Case Presentation

A 78-year-old man is admitted to the ICU for acute respiratory distress requiring endotracheal intubation. The patient was in his usual state of health and had seen his primary care physician earlier that day for a routine visit and influenza immunization. Later in the evening, the patient developed acutely worsening shortness of breath. He had no fever or chills, worsening cough, purulent sputum, wheezing, stridor, chest pain, palpitation, or known sick contacts. Family members noted that his face looked puffy, but he did not have lip or tongue swelling, difficulty swallowing, odynophagia, or a new rash. On ambulance arrival, the patient was noted to have significant respiratory distress. He was subsequently intubated at the scene and transferred to the hospital for further evaluation and management. The patient was known to have paroxysmal atrial fibrillation and COPD requiring 2 to 4 L of oxygen via nasal cannula at baseline. Social history was notable for prior use of tobacco. Family history was negative for allergies, pulmonary disease, and malignancy. The patient was last hospitalized for COPD exacerbation > 1 year prior to this admission. Otherwise, he remained adequately adherent to his COPD treatment.