Asthma Clinical Case Review

"His physical exam shows vital signs are normal, his oxygen level is 98% on room air. On exam, pertinent findings was that he had diffuse expiratory wheeze.

His skin showed dry skin, but no active lesions during the visit. His labs were pertinent for an immunoglobulin E of 382, and it was positive to tree pollen, grass pollen, dust mites, cat, dog, Alternaria mold, Aspergillus mold, and Candida albicans molds.

Complete blood counts showed a blood eosinophil level of 1000. Serum levels of immunoglobulin G, immunoglobulin A and immunoglobulin M were normal. Serum panel of Streptococcus pneumoniae antibodies, IgG, showed 48% of the serotypes positive, were at least four or at least 1.3 micrograms per mL. This is prior to vaccination of the pneumococcal polysaccharide polyvalent vaccine.

After vaccination, patient had an increase in percentages of serotypes to 96% or about 22 out of 23 serotypes. Serum level of antibody titers to tetanus toxoid and diphtheria toxoid was in range for protective titers. Antineutrophilic cytoplasmic antibodies, or ANCA, was negative.

So pulmonary function tests showed spirometry bronchodilator, a severe obstructive defect, with significant bronchodilator response. His FEV one was 38% after Bronco dilator increased to 53%. Lung volume showed an elevated total lung capacity and functional residual capacity, indicating hyperinflation and air trapping. Diffusing capacity was normal.

Chest x-ray showed a seven millimeter calcified pulmonary nodule posterior to the left hilum. Otherwise, his lungs were clear. CT scan of chest without contrast showed a seven millimeter calcified nodule in the posterior inferior left upper lobe and three millimeter calcified nodule in the medial left upper lobe. There was no lung consolidation or interstitial lung disease."