A 77-Year-Old Woman With Capillary Hypoxia and Perioral Cyanosis

CASE PRESENTATION: A 77-year-old woman with asthma, hypothyroidism, irritable bowel syndrome, overactive bladder, and multiple rheumatologic conditions was sent from the clinic to the ED for evaluation of hypoxia. In the clinic, she reported dizziness without shortness of breath and was noted to have perioral cyanosis with an oxygen saturation measured by pulse oximetry (SpO2) of 80%. She was given a nonrebreather mask delivering oxygen at 8 L/min, but the SpO2 remained at 77% to 82%. In the ED, the patient reported intermittent shortness of breath, 2 to 3 days of mild left lower extremity swelling, and a brief episode of lightheadedness earlier in the day that had since resolved. She denied fevers/chills, upper respiratory symptoms, and chest pain. She had been referred to the pulmonology clinic 3 years earlier to evaluate mild hypoxia with SpO2 readings in the low 90% range, but pul-monary function testing failed to identify an etiology. There was no history of VTE. Her rheumatologic conditions included osteoarthritis, rheumatoid arthritis, Sjogren's syndrome, and fibromyalgia.CHEST 2022; 162(6):e295-e299

Automated summary

A 77-year-old woman with multiple medical conditions was referred to the emergency department for evaluation of hypoxia. She presented with dizziness, perioral cyanosis, and low oxygen saturation. In the emergency department, she also reported shortness of breath, lower extremity swelling, and lightheadedness.