Dyspnoea on exertion

A 64-year-old woman visited our hospital with an initial symptom of dyspnoea on exertion. For the past 4 months, she had shortness of breath when she walked approximately 100 meters or went up 10 to 20 steps of a staircase. She visited her neighbouring hospital 1 month before visiting our hospital where she received a diagnosis of bilateral pleural effusions and seven sessions of thoracentesis; however, no clinical diagnosis could be made although her dyspnoea on exertion was slightly improved by the frequent thoracentesis. 

Examination

When she visited our hospital for the first time, she felt dyspnoea on exertion on the ground level after several hundred meters. She did not have any past history for opportunistic infections. A chest radiograph showed the enlargement of bilateral hilar shadows, reticulonodular shadows in bilateral lung fields, and dullness at the right costophrenic angle. Her serum angiotensin-converting enzyme (ACE) level was elevated to 44.2 IU/L. Her immunoglobulin G (IgG) and sIL2R levels were also elevated. Bacterial culture for sputum resulted in negative findings for tuberculosis. Polymerase chain reaction (PCR) analysis also showed no tuberculosis in her sputum.