A Healthy 22-year-old Woman With New Onset Dyspnea

An otherwise healthy 22-year-old woman sought treatment for acute dyspnea at the Johns Hopkins Hospital emergency department near the end of November 2006. The woman denied any history of asthma, allergies, smoking, or other pulmonary or cardiac disease. She had experienced a healthy childhood and was up to date with all standard immunizations. The young woman first noted dyspnea on exertion in late spring of the same year. By June, she reported, “I felt like I was going to die when I was swimming.” By July, the patient was experiencing dyspnea with mild exertion, and by August the symptoms occurred at rest. At that time, the patient went to her family physician, who diagnosed asthma and prescribed albuterol (Proventil, Ventolin). However, the inhaler provided no relief. That same month the woman was informed by her gynecologist that she had a positive human papilloma virus (HPV) test. She underwent a simple colposcopy the following week, and the condition required no further treatment. Lisa M. Robinson is Advanced Triage Nurse, Emergency Department, WellStar Kennestone Hospital, Marietta, GA.