This 57-year-old female with a distant history of ovarian cancer, rheumatoid arthritis with systemic lupus erythematosus features, and history of TTP, status post splenectomy, was admitted with fever, shortness of breath, and pleuritic chest pain. She was initially given cefuroxime and levofloxacin in the emergency department for a presumed community acquired pneumonia, as well as Lasix. Her medications included diltiazem 240 mg a day, lisinopril 40 mg a day, Naprosyn 500 mg b.i.d., NPH insulin 24 units subcutaneously q.a.m., Entex-LA, and Cardizem-CD 240 mg p.o. q.d. She underwent thoracentesis and multiple bilateral therapeutic pleuracentesis, and was diuresed aggressively with Lasix, with her oxygen requirement being down from initially 5 to 6 liters per nasal cannula prior to discharge. A continuous Doppler wave form was found and she underwent abdominal CT scan, which did not show any evidence of venous or lymphatic obstruction. Initially, she was started on cefuroxime and azithromycin by the General Medicine team, and her Legionella urine antigen became positive and levofloxacin was added given recommendations from the Infectious Disease Service. She was off of O2 except that she had desaturations to 86% with ambulation, therefore, she was discharged home with p.r.n. oxygen, on Lasix 80 mg b.i.d., insulin sliding scale, lisinopril 40 mg a day, and Cardizem-CD 240 mg p.o. q.d. and levofloxacin 500 mg times 14 days. An elevated platelet count up to 800 and an elevated CA-125 level was discussed with her GYN oncologist, and she was to follow-up with her doctor in one week.
has there been a prior lisinopril
lisinopril 40 mg a day,