A 51-year-old woman with a history of diabetes mellitus and anemia sought treatment at the emergency room for a 2-month history of dry cough and shortness of breath and a 1-week history of substernal chest tightness. One month before her presentation, she was seen at a separate hospital for dyspnea and was found to be anemic. She underwent chest radiography and CT scanning of the chest that was unrevealing to the cause of dyspnea. She received a blood transfusion, although no cause of the anemia was found. One week before presentation, she started experiencing dyspnea on exertion with associated chest pressure, prompting her to seek treatment at the emergency room. On presentation, she reported no fevers, night sweats, joint pain, paroxysmal nocturnal dyspnea, orthopnea, edema, palpitations, lightheadedness, or syncope. She noted a 10- to 20-pound involuntary weight loss over 5 to 6 months. Of note, she had never undergone esophagogastroduodenoscopy or colonoscopy. Medications included an oral diabetic medication. She had no significant family history. She never smoked and had no history of illicit drug or alcohol use.
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