A 79-Year-Old Man With Recurrent Respiratory and Constitutional Symptoms, Elevated Acute Phase Reactants, and Pancytopenia

CASE PRESENTATION: A 79-year-old man was examined because of recurrent dyspnea and constitutional symptoms that included malaise, fatigue, fevers, and arthralgias over the past 7 years. He was a nonsmoker who was a retired farmer. Elevated levels of acute phase reactants and C-reactive protein and a high erythrocyte sedimentation rate were noted often in his health records. However, an extensive rheumatologic evaluation, which included serologic studies (antinuclear antibodies, cyclic citrullinated peptide antibodies, antineutrophil cyto-plasmic antibodies) and temporal artery biopsy, had not shown an identifiable autoimmune disease. The patient had been treated intermittently with prednisone, with partial symp-tomatic improvement. Various cytopenias had been present over the preceding years; however, three bone marrow biopsy specimens showed moderately hypercellular bone marrow with no diagnostic findings. CHEST 2023; 163(5):e207-e210

Automated summary

A 79-year-old man with recurrent dyspnea and constitutional symptoms of malaise, fatigue, fevers, and arthralgias over the past 7 years was examined. Despite elevated acute phase reactants and inflammation markers, extensive evaluation did not reveal any identifiable autoimmune disease. Treatment with prednisone provided partial symptomatic improvement. Various cytopenias were present, but bone marrow biopsies did not show any diagnostic findings.