This is a 20 y/o woman seen last week. She is previously healthy with no label of lung disease. For the past 3-4 weeks she has had a dry cough with occasional expiratory wheezing and episodic dyspnea on exertion. No fevers/chills/NS/sputum production. She has also recently been diagnosed with mild iron-def. anemia and has been started on iron.
No PMHx.
Meds: prn albuterol (seems to help), PPI and Iron sulfate. Up to date on immunizations including typhoid, hep A and hep B.
SHx: No TOB/ETOH/IVDA. College student. Last year she spent 6 weeks in Peru in the poor outskirts of Lima as a missionary. She had a brief episode (2 days) of diarrhea and no other problems. She returned a month ago from 6 weeks as a missionary in Hong Kong.
FHx: non-contributory.
ROS: only respiratory complaints noted above.
On exam, WN/WD, in NAD. VS normal. HEENT WNL. Chest with occasional rare expiratory wheezing but overall good aeration. Normal heart, abdomen, extremities. No rash.
Spiro revealed normal FVC with FEV1~75%. Normal TLC and DLCO with increase RV/TLC.
Normal CxR.
What is your DDx and what would you do next?
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Well, since you are posting this case and it involves Peru, I will put strongyloides on the list. This is because of the gastroenteritis and now a dry cough (and wheezing). I would check stool for O&P, check the CBC for eosinophils. I would probablky get a CXR to rule out other surprises, but with this type of infection I realize it would be negative.
The other thing about the PFT's: was the flow volume loop ok? Just to make sure there is no upper airway abnormalities in terms of inspiratory-loop flattening.
The FVL was OK: a little coving but PIF and PEF were OK.
The American Lung Association has a session on asthma and its management and might be a good starting point: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33276
If your son has frequent attacks he should be seen by a pulmonary specialist in you area.
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