A 17-Year-Old Male Subject With Chest Pain, Worsening Dyspnea, and a Rare Complication

      A 17-year-old male subject with allergic asthma since childhood was transferred from a local hospital to our Department of Pediatrics with reports of chest pain preceded by 3 days of a dry cough and worsening dyspnea. In the last year, he had been controlling his asthma symptoms exclusively with salbutamol, several times a month. The patient had smoked marijuana and tobacco on the previous morning of admission. He denied neurologic complaint, air travel, trauma, or vomiting. On physical examination, the patient was nontoxic appearing but was short of breath and unable to speak in full sentences. He was afebrile with an initial heart rate of 134 beats/min, a respiratory rate of 35 breaths/min, and room air pulse oximetry of 90%. Blood analysis revealed no significant changes, except for a neutrophil count of 14.62 × 103/μL and a C-reactive protein level of 1.80 mg/dL. Pulmonary examination revealed moderate respiratory distress using accessory muscles of respiration with expiratory wheezing. On neck examination, the patient’s trachea was midline with palpable crepitus mainly in the right side with no jugular venous distension. His ECG showed sinus tachycardia with no right ventricular overload data or changes in the ST segment. Furthermore, specific cardiac injury markers were negative.
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