We report a case of dilated cardiomyopathy with mural thrombus presenting in an atopic patient with symptoms of reactive airways disease.

A 47 year-old female presented to the Allergy Clinic during the spring season with rhinitis, ocular pruritus, cough, chest tightness and wheeze. Allergy skin testing showed reactivity to tree pollens and dust mites. A chest film showed a mild lingular infiltrate. Pulmonary function test showed mild obstructive airway disease. She was treated with azithromycin, beclomethasone diproprionate 80 ug, 2 puffs twice daily, albuterol as needed and a short Prednisone taper. Her symptoms improved. Four weeks later, she experienced a recurrence of cough, nocturnal wheeze, dyspnea and tachycardia. When her symptoms persisted despite the use of fluticasone proprionate,220 ug, salmeterol and monteleukast, a repeat chest film was obtained.

The chest film showed a mild cardiomegaly compared with her previous chest x-ray. An echocardiogram revealed a dilated cardiomyopathy with a left ventricular mural thrombus. D-Dimer was positive. Doppler study of the lower extremities was normal. She was started on digoxin, furosemide, warfarin sodium and lisinopril and has done well off all asthma medications.

Allergists should maintain a high index of suspicion in cases where symptoms suggestive of reactive airway disease may be masquerading as another unexpected disease entity.