• Awan K Rahman, Santo Longo, Liyan Xu, Steven Tellschow, Neil Belman, and Yaniv Dotan.
• Section Pulmonary and Critical Care, St. Luke's University Health Network, Bethlehem, PA. Electronic address: awanrahmna90@gmail.com.
• Chest. 2021 May 1; 159 (5): e337-e342.

Case PresentationA 62-year-old man presented with a 3-month history of shortness of breath and a dry cough. He had a medical history of hypertension (without use of angiotensin-converting enzyme inhibitors), hyperlipidemia, depression, and 10-pack-years of cigarette smoking several decades ago. He was a limousine driver and denied any history of occupational high-risk exposures. The patient denied significant weight gain or weight loss, night sweats, fevers, hemoptysis, chest pain, or palpitations. He had a normal physical examination. Pulmonary function studies with a hemoglobin level of 12.9 gm/dL revealed normal spirometry, normal lung volumes, and moderately low diffusion capacity (56% of predicted). A 6-minute walk test showed mild desaturation (97% to 92% after 432 m). Stress echo revealed ejection fraction of 60% with no regional wall motion abnormalities, no evidence of impaired diastolic filling, estimated peak pulmonary artery pressure 35 to 40 mm Hg, and no valvular abnormalities with desaturation to 87% during the test. Extensive rheumatologic, infectious disease, and hypercoagulability workup were unremarkable. BAL was negative for malignancy, infection, or eosinophilic lung disease.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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