C L E V E L A N D C L I N I C J O U R N A L O F M E D I C I N E V O L U M E 7 4 N U M B E R 1 2 D E C E M B E R 2 0 0 7 877 DEEPA KABIRDAS, MD Department of Internal Medicine,
Cleveland Clinic Florida, Weston, FL BIANCA AFONSO, MD Department of Internal Medicine,
Cleveland Clinic Florida, Weston, FL HERNAN AVELLA, MD Department of Internal Medicine,
Cleveland Clinic Florida, Weston, FL An elderly woman with asthma,
eosinophilia, and septic shock 76- YEAR - OLD WOMAN is admitted with nausea and vomiting of 1 weeks dura- tion. She was diagnosed with severe asthma 6
years ago and has been hospitalized for it mul-
tiple times, most recently 1 week ago. That
hospitalization was complicated by respiratory
failure which required intubation and high-
dose intravenous corticosteroids. Since then,
she has been taking prednisone daily but her
asthma remains poorly controlled and she has
been using her albuterol inhaler every day as
rescue therapy. She has not traveled recently
or had contact with anyone who is sick. She
was born in Cuba and moved to Florida 20
years ago. On physical examination she is afebrile and her vital signs are normal. Lung examina-
tion reveals bilateral coarse breath sounds
with a prolonged expiratory phase. She has
mild epigastric tenderness, but no rigidity or
guarding. The remainder of the physical
examination is unremarkable. Her white blood cell count is high, with 17.5% eosinophils (normal 04) and
an absolute eosinophil count of 2.905