ABSTRACT
CASE PRESENTATION: A 21-year-old man presented to the ED of The George Washington University Hospital complaining of chills, shortness of breath, hemoptysis, and a generalized rash. Three days before admission, he noticed a productive cough, severe sore throat, and subjective fever. He also experienced extreme fatigue, generalized sweating, and chest pain with coughing. On the day before admission, he experienced a nonpruritic rash on his neck, palms, and dorsal surfaces of his feet and sputum with streaks of blood. The patient had no significant medical or family history. He had no sick contacts, and his only recent travel was to an outdoor concert in a woody area of the northeastern United States about a month earlier. He did not report recent contact with birds or visits to caves. He is single, lives alone in an apartment, and consumes about 4 alcoholic beverages a week. Occasionally, he smokes cannabis and e-cigarettes. He is sexually active with men, and his last unprotected sexual encounter was a month earlier. He denied photophobia, rhinorrhea, ear pain, nasal congestion, abdominal pain, nausea, vomiting, diarrhea, or dysuria.
Subject(s)
Pneumonia, Mycoplasma/diagnosis , Pneumonia, Necrotizing/diagnosis , Exanthema/etiology , Hemoptysis/etiology , Humans , Immunocompetence , Male , Pneumonia, Mycoplasma/complications , Pneumonia, Necrotizing/complications , Young AdultABSTRACT
Neurofibromatosis type 1 is a rare disorder that occurs secondary to pathogenic variants in the NF1 tumor suppressor gene on chromosome 17. Characteristic clinical manifestations include multiple hyperpigmented macules, axillary and inguinal freckling, optic gliomas, and numerous skin neurofibromas. Vasculopathies are a rare complication of this disease and can affect vessels ranging from the proximal aorta to small arterioles, with pathology including arterial stenosis, aneurysms, and arteriovenous malformations. Aneurysms in these patients are often asymptomatic, and most patients with this complication appear for treatment after vessel rupture. We describe a 33-year-old man with neurofibromatosis type 1 who presented with chest pain and was ultimately found to have a ruptured left subclavian artery branch pseudoaneurysm leading to a large hemothorax.
