• Matthew K Hensley and Jane C Deng.
• Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI. Electronic address: hensleymk2@upmc.edu.
• Chest. 2020 Dec 1; 158 (6): e279-e282.

Case PresentationA 35-year-old veteran presented at our clinic with insidious dyspnea on exertion, nonspecific chest pain, and intermittent rash. The patient reported the development of dyspnea over 6 to 8 weeks. He had been physically active before this time but had since developed dyspnea after walking 30 to 61 m (100 to 200 ft) or with any more strenuous physical exertion. He described a nonproductive cough, with bilateral nonspecific chest pain that was worse with exertion. In addition, there was a fleeting, salmon-colored, nonpruritic rash over the bilateral arms and legs that was not responsive to over-the-counter topical steroids. The patient's medical history was notable for a 15-pack-year smoking history, posttraumatic stress disorder, depression, Clostridium difficile colitis, migraines, and alcohol abuse. Surgical history was notable for pyloric myotomy for stenosis and umbilical hernia repair. He lived with his partner and five children and was unemployed at the time because of dyspnea. There were no pets in the home and no prior occupational exposures, including silica, heavy metals, or birds.Copyright © 2020 American College of Chest Physicians. All rights reserved.

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