A 50-Year-Old Woman With Shortness of Breath

      A 50-year-old woman was admitted in the hospital for shortness of breath. The shortness of breath was insidious in onset, starting 7 days before presentation, when she ran out of her prescription furosemide. The shortness of breath worsened rapidly on the day of presentation, being present at rest and briefly requiring humidified high-flow oxygen by nasal cannula. She had a history of active hepatitis C with a very high viral load (505,908 IU/mL), cirrhosis complicated by esophageal varices, two episodes of pulmonary embolisms, severe pulmonary hypertension, and resultant chronic cor pulmonale as well as chronic hypoxic respiratory failure supported by home oxygen therapy 4 to 6 L/min. COPD was suspected, but she did not have a pulmonary function test. Her medications included alprazolam, mirtazapine, furosemide, omeprazole, senna-docusate and polyethylene glycol. She lived with her husband at home, smoked five to 10 cigarettes every day, and abused intravenous heroin quite frequently.
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