View Abstract

A2187 - Asthma Mimickers: An Everyday Challenge
Author Block: M. Munawar1, V. Kodadhala2, W. Ahmed3, W. Hill4, F. T. Ogundipe5, A. Thomas6; 1Internal Medicine, Howard University Hospital, Washington, DC, United States, 2Pulmonary Medicine, Howard University Hospital, Washington DC, DC, United States, 3Internal Medicine, Howard University Hospital, Washington DC, DC, United States, 4Med Student, Howard University School of Medicine, Washington DC, DC, United States, 5Pulmonary Medicine, Howard University Hospital, Washington, DC, United States, 6Howard University Hospital, Silver Spring, MD, United States.
INTRODUCTION: The diagnosis of Asthma is not often disputed or debated. However, all that wheezes is not due to asthma. Certain intra and extra thoracic medical conditions can mimic asthma and the initial presentation can be wheezing. We report a case of a 27-year-old male who presented with symptoms of wheezing and was diagnosed with asthma by his primary-care-physician and later on found to have a mediastinal mass. Case: A 27-year-old Hispanic male presented to a health-facility with wheeze and shortness of breath on exertion. He was diagnosed to have asthma based on these symptoms alone. Despite being compliant with bronchodilator inhalers he remained symptomatic. A few months later, he presented to our hospital emergency room for a shoulder injury. On review of systems, patient reported low grade fever and night sweats. On physical exam patient had localized right lower lobe wheezing. X-ray of the shoulder was obtained which revealed a large intra-thoracic mass. Later CT chest was obtained which revealed large complex anterior and right mediastinal mass that measured 14x10x10cm , with heterogeneous contents, calcification and the medial margin blended with the cardiac silhouette . CT guided biopsy revealed Large B Cell lymphoma. Radiotherapy was initiated and the patient received 5 rounds of radiotherapy. His wheezing symptoms and shortness of breath improved post radiotherapy. Chemotherapy treatment was initiated. Discussion: Asthma typically presents with symptoms of shortness of breath, chest tightness, wheeze and cough and is caused by hyper-reactivity of airways due to inflammation and narrowing of the airways. In patients presenting with these symptoms, Asthma is often one of the main differential diagnosis that physicians consider. It is important to remember all that wheezes is not asthma. There needs to be increased awareness among physicians on other systemic and local intra-thoracic diseases including lymphoma that can mimic Asthma. Some of these may be life-threatening,requiring timely diagnosis and appropriate management to decrease morbidity and mortality. The presentation of a localized wheeze should raise concern for other ominous differentials as well as when standard asthma treatment does not provide adequate symptom control in patients with persistent wheezing. Mimickers of asthma require a heightened clinical suspicion to accurately diagnose the underlying condition. Conclusion: Localized wheezing should be further evaluated. This case highlights the importance of thorough review of radiological imaging, peak expiratory flow and other investigations before diagnosing any patient with asthma especially if they have inadequate response to empiric bronchodilator therapy.