Author: Katherine Bohringer, DO
Co Author #1: Karl B. Fields, MD, CAQSM, FAMSSM
Senior Editor: Jessalynn Adam, MD
Editor: Jeffrey Feden, MD, FAMSSM

Patient Presentation:
A 58-year-old male presented to clinic with complaint of recurrent hemoptysis during open-water triathlon events.

History:
The patient competed in an elite triathlon competition during the spring of 2020 when he suddenly experienced shortness of breath and hemoptysis 200 meters into the swimming event. He experienced frank hemoptysis and was evacuated from the water. He was noted by emergency medical personnel at the event to have an oxygen saturation of 88% and was transported to a local emergency department. In the emergency department, CT scan demonstrated peribronchiolar infiltrates throughout, greatest in the upper lobes. Sputum cultures revealed Klebsiella, and patient was treated with a week of Levaquin. Tuberculosis testing was also positive, and he was treated with prolonged course of Rifampin. Repeat CT showed resolution of his pulmonary infiltrates, though did note incidental coronary artery calcifications. After completing his antibiotic course, the patient again attempted to complete a triathlon, but he unfortunately experienced a recurrence of his hemoptysis causing him to drop out of the race. He recovered uneventfully over night at home and later presented to the sports medicine clinic for evaluation.

Physical Exam:
On examination, the patient was normotensive and breathing comfortably. His lungs were clear to auscultation, and his heart rate was regular with no murmurs. He had no bruits appreciated either from his carotids or on his abdominal examination. His musculoskeletal examination was unremarkable, with full and comfortable range of motion and strength testing.

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