CASE REPORT JAAPA Journal of the American Academy of Physician Assistants www.JAAPA.com CASE A 27-year-old woman presented with a 1-day history of sudden onset of shortness of breath and cough with blood- streaked sputum. The patient’s vital signs at presentation were: BP, 150/108 mm Hg; heart rate, 142 beats/minute; respirations, 30; and Spo 2 , 60% on room air, requiring oxygen supplementation of 15 L/min via nonrebreather mask. History The patient had a history of migraines. She was a nonsmoker and denied consumption of alcohol or illicit drugs. She had no history of fever, chest pain, viral pro- drome, nausea, vomiting, or unintended weight loss. Physical examination In the ED, the patient’s condition rapidly worsened as her systolic BP dropped to 60 mm Hg and her diastolic BP was unrecordable. Her Spo 2 was 93% on supplemental oxygen and her heart rate was 150 beats/minute. The physical examination was significant for bibasilar crackles without wheezes. A cardiovascular Santosh Nepal practices in the Department of Hospitalist Medicine at Rapid City (S.D.) Regional Hospital. Smith Giri is a resident in internal medicine at the University of Tennessee Health Science Center in Memphis, Tenn. Mohan Bhusal is a medical intern in the Department of Internal Medicine at Tribhuvan University Teaching Hospital in Kathmandu, Nepal. Krishmita Siwakoti is a resident in internal medicine at the University of Tennessee Health Science Center. Ranjan Pathak is a resident in internal medicine at Reading Health System in West Reading, Pa. The authors have disclosed no potential conflicts of interest, financial or otherwise. DOI:10.1097/01.JAA.0000490945.35987.83 Copyright © 2016 American Academy of Physician Assistants An uncommon cause of acute pulmonary edema Santosh Nepal, MBBS; Smith Giri, MD; Mohan Bhusal, MBBS; Krishmita Siwakoti, MBBS; Ranjan Pathak, MBBS ABSTRACT Acute cardiogenic pulmonary edema secondary to catecholamine-induced cardiomyopathy is a very uncom- mon and fatal initial presentation of pheochromocytoma. However, with early clinical suspicion and aggressive management, the condition is reversible. This case report describes a patient who presented with hypertension, dys- pnea, and cough with bloody streaks, and who recovered within 48 hours after appropriate treatment. Keywords: pheochromocytoma, acute pulmonary edema, ST-segment elevation, hypertension, respiratory distress, cardiomyopathy FIGURE 1. Coronary angiogram revealing normal appearing left (A) and right (B) coronary arteries without any luminal irregularities A B Copyright © 2016 American Academy of Physician Assistants