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Endgames Case Review

A man in his 30s with recurrent cough, fever, dyspnoea, and chest pain

BMJ 2022; 377 doi: (Published 01 June 2022) Cite this as: BMJ 2022;377:e069446

This article has a correction. Please see:

  1. Xuanna Zhao, attending respiratory physician,
  2. Yu Jie Huang, junior respiratory physician,
  3. Bin Wu, consultant respiratory physician,
  4. Dong Wu, consultant respiratory physician
  1. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
  1. Correspondence to D Wu wudong98{at}

A man in his 30s was admitted to the respiratory and critical care ward with a >2 month history of recurrent cough, fever, dyspnoea on exertion, and pleuritic pain in the left hemithorax but no haemoptysis.

Two months earlier, chest radiography had shown pulmonary infiltrates, and antibiotic treatment was unsuccessful. One month earlier, pulmonary embolism (PE) was diagnosed after blood gas analysis showed hypoxaemia, and chest computed tomography pulmonary angiography (CTPA) showed multiple filling defects affecting the main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA). At that time, the patient’s laboratory results, compression ultrasonography (CUS), and echocardiography were normal, and he was treated with rivaroxaban and discharged.

At this latest presentation, his heart rate was 78 beats/min, temperature 36.7°C, respiration rate 21 breaths/min, blood pressure 119/76 mm Hg, and oxygen saturation was 97% on room air. Chest, abdominal, and lower limb examination was normal. Routine blood tests, blood gas analysis, testing for troponin I, B-type natriuretic peptide, and prothrombin time, and thrombophilia screening were …

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