A 46-year-old man with dyspnea and left diaphragm paralysis

Abstract

A 46-year-old man was referred because of increasing shortness of breath. His symptoms started 1 year prior after he fell while working in Iraq as a contractor. Progressively increasing shortness of breath developed on exertion with a nonproductive cough, and he could walk only 50 ft on presentation. Additional symptoms were occasional dysphagia, diplopia, mild short-term memory problems, morning headaches, hypersomnolence, and severe fatigue toward the end of the day. His medical history included coronary artery disease, obesity, obstructive sleep apnea, hypertension, dyslipidemia, and chronic low back pain, and he was an ex-smoker of 50 pack-years. The patient was on leave from work secondary to his shortness of breath and back pain. He was receiving the following medications: morphine sulfate, sustained release; cyclobenzaprine; tramadol; atorvastatin; clopidogrel; metoprolol; furosemide; and lansoprazole.