Breathing space

Persistent pulmonary symptoms see one patient undergo a battery of tests before a diagnosis of cardiopulmonary sarcoidosis is reached

Jennifer, a 56-year-old non-smoker, was referred to our respiratory clinic for assessment of a persistent dry cough and shortness of breath on exertion. She also complained of mild chest tightness.

Jennifer’s symptoms had persisted after antibiotic treatment for pertussis four months ago. Her GP had commenced her on empirical bronchodilator therapy without benefit; she has also tried herbal treatment and acupuncture without success.

A respiratory function test was normal and a mannitol challenge test did show any evidence of bronchial hyper-responsiveness. 

On examination, there was no evidence of arthritis, skin rash, conjunctivitis or palpable cervical lymph nodes. On auscultation, there were normal bronchovesicular sounds throughout her chest. Her cardiovascular and upper airway examinations were also normal. 

Jennifer said her chest X-ray had been unremarkable. So, to investigate