SHM Converge Scientific Abstract ePoster Gallery-Betting in the Blind: An Emr Misdiagnosis Leading to Treatment Delay

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This case highlights the danger of “diagnostic momentum,” where an initial diagnosis is carried forward without adequate reconsideration. The patient was treated for COPD and heart failure for one week, despite lacking key supporting features such as a smoking history and pulmonary function testing.<br /><br />Further evaluation showed that the original diagnosis was incorrect. Physical exam revealed bilateral crackles and wheezing with trace leg edema and obesity. Pulmonary function tests were not consistent with COPD; instead, they suggested a restrictive or mixed pattern with severely reduced diffusion capacity. CT chest demonstrated diffuse mosaic attenuation with air trapping and mild tree-in-bud nodularity, findings concerning for bronchiolitis obliterans. Hand radiographs showed erosive inflammatory arthritis. Laboratory studies supported autoimmune disease, including markedly elevated RF, CCP antibodies, ESR, CRP, and positive ANA, while ANCA, dsDNA, and ENA were negative.<br /><br />The final diagnosis was seropositive erosive rheumatoid arthritis with associated bronchiolitis obliterans. The patient was started on azithromycin, with outpatient plans to begin azathioprine.<br /><br />The case emphasizes that COPD diagnosis requires the appropriate clinical context, symptoms, and confirmatory spirometry. Misdiagnosis can delay correct treatment and worsen outcomes. Hospitalists should remain vigilant for alternative explanations when the clinical picture does not fit the presumed diagnosis.

Asset Subtitle

Marcela Araujo De Oliveira Santana

Meta Tag

Author List Ann Marie Kumfer, Marcela Araujo De Oliveira Santana, Noah Romero Nakajima

Category Clinical Vignettes

Concept Diagnostic Reassessment

Concept Rheumatoid ArthritisAssociated Bronchiolitis Obliterans

Concept Diagnostic Momentum

Concept Rheumatoid Arthritis

Concept Chronic Obstructive Pulmonary Disease

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis

Presenting Author Marcela Araujo De Oliveira Santana

Track Adult

Keywords

diagnostic momentum

COPD misdiagnosis

rheumatoid arthritis

bronchiolitis obliterans

pulmonary function tests

mosaic attenuation

air trapping

erosive inflammatory arthritis

autoimmune disease

azithromycin

Diagnostic Reassessment

Rheumatoid ArthritisAssociated Bronchiolitis Obliterans

Diagnostic Momentum

Rheumatoid Arthritis

Chronic Obstructive Pulmonary Disease