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Case Report: Shortness of Breath After Cefalexin

Our latest case report from Brady Pregerson, MD, features a 62 y/o male with a history of obesity, CAD, anxiety, and COPD presenting with SOB after stating cefalexin. Can you determine the correct diagnosis?

History: A 62-year-old male with a history of obesity, coronary disease, anxiety, and COPD presents to the emergency department for 2 days of intermittent shortness of breath after starting Keflex for cellulitis. He denies any chest pain, fever, rash, throat or lip swelling, or cough. He states the SOB seems to get worse about an hour after taking Keflex but then gradually gets better, which is why he thinks it may be an allergic reaction. His inhalers don’t seem to help.

Exam: Vital signs are normal including pulse ox and respiratory rate. Exam is otherwise normal except for the cellulitis which is both in his groin below his pannus and in his right lower leg. Specifically, there is no rash, oral swelling, rales, or wheezing.

An EKG is performed:

Based on this EKG, what diagnosis should you suspect?

A) Anxiety

B) Allergic reaction

C) Pulmonary Embolism

D) Acute Coronary Syndrome

E) COPD exacerbation