Course 19, case 1
Revised 2010
Kas 19-1E: Patient with dyspnoe (bronchospasm) and mucosal symptoms
Present history: 25 years old patient presented at emergency with night shortness of breath,
with wheezing, water rhinorrhea and swelling of the eyelids. Recently (from March to April),
the symptoms have been more intensive (serous nasal secretion, swelling of the eyelids,
itching and conjunctivitis). About a week, he has dyspnoe during the night, he describes
"wheezing" and dry cough, shortness of breath on exertion.
Family history: His mother is treated for pollen allergy.
Personal history: He has never been seriously sick.
Medication: He has no regular medication.
Abuse: He is a smoker (10 years 10 cigarettes per day).
History of allergy: He suffers from allergy to cat - sneezing during the contact with any cat,
sometimes nasal symptoms with any evident animal contact. He has no allergy to drugs, food
and insect sting. 3 year ago, he was tested for allergy, the sensitization to birch pollen, cat and
house dust mite was found. He refused any treatment.
Physical examination: eutrophic, eupnoe, swelling of the eyelids, conjunctivitis, serous
rhinitis, alveolar breathing with wheezing, heart rate 68/min., BP 125/80.
Laboratory:
Biochemistry - normal findings. Blood count - eosinophil percentage 14.
Pulmonary function tests: VC 94,9%, FVC 87,6% FEV1 76,1%, PEF 64,3 % of reference
values.
Questions:
1. Describe mechanism of skin tests with allergen.
2. What is the pathophysiology mechanism of such a type of breathlessness and mucosal
changes?
3. Characterize basic allergens, able to trigger disease symptoms.
4. What further tests will you recommend (diagnosis confirmation and the estimation of
stage of the disease)?
5. What is the probable disease?
6. What will be the treatment approach?
7. What can be complications if no treatment will be started?
8. Pathology – Bronchial asthma