3090D553-9492-4563-8681-AD288FA52ACE

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 48-year-old woman presents with hoarseness of 8 months' duration. She first noticed crackling of her voice, which was worse when she laughed. This progressed to difficulty talking and now limits her ability to speak. She also reports difficulty breathing; she has an inspiratory and expiratory wheeze and an occasional nonproductive cough. She cannot recall any precipitating events. She has no fever or chills and reports no sick contacts. She takes antacids for acid reflux.

The patient has a history of hypertension and paroxysmal supraventricular tachycardia. She previously underwent an ablation procedure for the cardiac arrhythmia and is being treated with a beta-blocker.

Six years earlier, the patient received a diagnosis of stage II right breast cancer. She underwent a bilateral skin- and nipple-sparing mastectomy with right sentinel lymph node biopsy. The final pathology results of the right breast biopsy demonstrated a grade 3 infiltrating ductal carcinoma, which measured 2.2 × 1.3 cm. The tumor was estrogen receptor negative (ER-), progesterone receptor negative (PR-), and human epidermal growth factor receptor 2 positive (HER2+). Three sentinel lymph nodes were removed, which were negative for metastatic carcinoma. The final pathologic staging was pT2N0. After surgery, she received adjuvant chemotherapy consisting of doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab. She remains free of disease.

Her family history is significant for cancer and Hashimoto thyroiditis. Her daughter had pilocytic astrocytoma, her maternal grandmother had kidney cancer, her maternal grandfather had prostate cancer, and her paternal aunt had breast cancer. Both her mother and sister have Hashimoto thyroiditis.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Hoarseness and Wheezing in a 48-Year-Old With Arrhythmia - Medscape - Feb 21, 2024.

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