Case Presentation

A 66 year-old male presented to the emergency department (ED)with complaints of two days of shortness of breath and pruritis.The patient claimed that he had not had regular medical care formore than 15 years and admitted to no past medical history orchronic medications. One week prior, he reported an itchy rashon both his forearms. He sought treatment at a local free clinicand received a low-potency steroid cream which he used withoutrelief. While at a family event, he became increasingly dyspneicand was brought to the ED by his family. He reported no surgicalhistory and no drug allergies or food intolerances. The patientreported moderate alcohol use with one to two beers per day anddenied any tobacco use, substance abuse, or intravenous druguse. He could report no pertinent family history.