Methods: Our patient was referred for evaluation and treatment of moderate persistent asthma.
Results: A 52 year old woman with a Factor V Leiden mutation presented with a history of moderate persistent asthma. Symptoms included cough, wheezing, and shortness of breath. She had been previously treated with montelukast with no significant benefit. She could not tolerate medications with long-acting beta agonists due to anxiety side effects. She was placed on fluticasone proprionate 220 mcg two puffs twice daily with benefit. However, after two months, she developed worsening shortness of breath symptoms with wheezing. On exam, she had normal heart rate (80), respiratory rate (12), and blood pressure (110/70). Lung exam was clear to auscultation without any wheezes, rhonchi, or rales. Fluticasone dose was increased with some benefit in two days, however, mild symptoms still occurred. She then developed chest discomfort, which was exacerbated by arm movement. She was referred to emergency department for further evaluation, and CT pulmonary angiography revealed a pulmonary embolism. She was successfully treated with anticoagulant therapy.
Conclusions: This case demonstrates the importance of considering pulmonary embolism in the differential diagnosis of an asthma exacerbation, especially in a patient with a hypercoagulable state, such as Factor V Leiden.