Dyspnoea, cough, edema: Heart failure or what else?

Abstract

We present the case of a 55-year-old man admitted for dyspnea, cough and edema of the legs and feet. The patient, a smoker with psoriasis at hands and feet noted the comparison, three years ago, of marked thickening and yellow discoloration of the nails. The chest X-ray showed a right-sided pleural effusion with parenchymal atelectasis. The cytologic examination of pleural fluid revealed mesothelial cells with inflammatory changes. The bacterial culture of the pleural fluid was negative and pleural biopsies revealed fibrosis. To reduce dyspnoea and formation of pleural fluid, was performed a pleurodesis by talcage. The patient was discharged with itraconazole, high dose vitamin E and zinc supplements as home therapy. The correct diagnosis was not easily achieved because the patient had symptoms and signs referable to other diseases as heart failure or venous insufficiency or psoriasis.