1/14. Near fatal acute respiratory distress syndrome in a patient with human ehrlichiosis.Human ehrlichiosis is not a common cause of acute respiratory distress syndrome (ARDS). physicians should be aware of this life-threatening but treatable entity. Progression to ARDS may be related to delay in diagnosis and treatment. fever, leukopenia, thrombocytopenia, and a history of tick exposure in an endemic area during the spring and summer months should alert the physician to the possibility of human ehrlichiosis, since a definitive diagnosis requires serologic testing that may take weeks to confirm. We describe a case of ARDS resulting from human ehrlichiosis. A unique feature in our case was that despite the early use of doxycycline, the patient had near fatal ARDS that responded dramatically to high doses of steroids.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. ehrlichiosis with severe pulmonary manifestations despite early treatment.It is generally thought that if patients with ehrlichiosis are treated promptly, life-threatening illness can be avoided. We report a patient who sought medical attention 1 day after the onset of symptoms, was immediately given doxycycline, and still had serious illness with generalized edema, pulmonary infiltrates, acute respiratory distress syndrome, and noncardiogenic pulmonary edema, while receiving replacement intravenous fluids. This case alerts physicians to the serious end of the disease spectrum that can occur even though patients are given prompt, appropriate drug treatment at the onset of illness. Further studies are needed to clearly define the mechanisms involved in pulmonary complications and generalized edema, including noncardiogenic pulmonary edema, in patients with ehrlichiosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. The therapeutic dilemma of an ectopic pregnancy in the setting of the severe ovarian hyperstimulation syndrome.Severe ovarian hyperstimulation syndrome as a result of assisted reproductive therapy occurs rarely. However, this iatrogenic condition can result in a life threatening illness with difficult management dilemmas for the attending physicians. A patient with severe adult respiratory distress syndrome and septicaemia after in vitro fertilization required prolonged intensive care treatment and subsequently had a probable ectopic pregnancy treated with systemic methotrexate as an alternative to surgical management. A satisfactory outcome was obtained, followed by a spontaneous successful pregnancy some months after these events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Atypical fulminant rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and adult respiratory distress syndrome.Brazilian spotted fever, caused by rickettsia rickettsii, has been increasingly reported in brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with adult Respiratory Distress Syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Transfusion-related acute lung injury during plasma exchange: Suspecting the unsuspected.Transfusion-related acute lung injury (TRALI) has been implicated with use of almost all types of blood products that contain variable amounts of plasma. Even though the reported incidence of TRALI is rare, its overall occurrence is thought to be more common, as less severe cases remain unreported. More TRALI cases are unrecognized and misdiagnosed due to lack of suspicion and absence of appropriate investigation. There are exceedingly rare reports of TRALI during plasma exchange despite the fact that liters of plasma may be used for replacement during a single procedure. We describe a mild case of TRALI during plasma exchange for thrombotic thrombocytopenic purpura in a 56-year-old woman, status post autologous hematopoietic stem cell transplant for non-Hodgkin's lymphoma. She developed severe rigors, peripheral cyanosis, hypoxia, and a transient diffuse pulmonary infiltrate. Of the 10 U of plasma used, one was from a multiparous female donor with HLA antibodies reactive with patient's granulocytes in immunofluorescence and agglutination assays. This case emphasizes the fact that the physicians and apheresis staff should consider TRALI in the differential diagnosis for patients developing respiratory distress during or soon after the procedure. Diagnosing TRALI has implications not only for the plasma exchange recipient, but also for the management of donors found to have leukocyte antibodies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Neuroleptic-induced acute respiratory distress syndrome.CONTEXT: A case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. CASE REPORT: A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air), Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2) with FiO2 50% (PaO2/FiO2 130), and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Acute resin phenol-formaldehyde intoxication. A life threatening occupational hazard.1. A 38-year-old previously healthy worker accidentally spilled phenol-formaldehyde resin over a large area of his skin. 2. Several days later he was hospitalized with extensive necrotic skin lesions, fever, hypertension, adult respiratory distress syndrome (ARDS), proteinuria and renal functional impairment. 3. All symptoms improved progressively and eventually disappeared. 4. We propose that toxic materials originating from the necrotic skin lesions and the continued facilitated absorption of the resin and/or its components via the skin lesions were the main factors responsible for this alarming multisystem involvement. 5. Workers handling this material should be instructed to take appropriate precautions and physicians should be alerted to the potential pathophysiological consequences.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Chronic eosinophilic pneumonia: a cause of adult respiratory distress syndrome.It is important that physicians not overlook the diagnosis of chronic eosinophilic pneumonia (CEP), since this disorder is readily reversible with corticosteroid therapy. Six patients with CEP were seen at our institution between 1979 and 1983. We present their clinical features, chest films, and pathologic findings, and review the literature on CEP. While most of our patients had the classic chest x-ray pattern of peripheral opacities in a nonsegmental distribution, two had atypical features with diffuse abnormalities on x-ray films. In fact, the two patients who had adult respiratory distress syndrome (ARDS), presented diagnostic difficulty and required admission to the intensive care unit. In contradistinction to the four patients with classic CEP, the two with ARDS had a delayed response to corticosteroids. Therefore, we conclude that chronic eosinophilic pneumonia is an important entity to recognize as a potentially fatal cause of the adult respiratory distress syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. A case report of disseminated blastomycosis and adult respiratory distress syndrome.blastomycosis is a fungal disease endemic to the midwestern and southeastern united states. This is a case report of a 29-year-old woman who presented with weight loss, fever, fatigue, and pneumonia. She developed disseminated blastomycosis, adult respiratory distress syndrome (ARDS), and ulcerative skin lesions, requiring mechanical ventilation, amphotericin b, and multiple surgeries. blastomycosis is endemic to a large portion of the United States. family physicians should consider fungal infection in the differential diagnosis of an unresolving pneumonia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. cytarabine-induced pericarditis: a case report and review of the literature of the cardio-pulmonary complications of cytarabine therapy.pericarditis is a rare complication of chemotherapy. This report describes a patient who developed symptoms, signs, and electrocardiographic evidence of pericarditis following treatment with high dose cytarabine. The patient had no clinical or echocardiographic evidence of infection or leukemic involvement of the pericardium. Isolated pericarditis associated with high dose cytarabine has been rarely reported. This therapy is frequently used and, therefore, it seems prudent to alert physicians to this potential complication of cytarabine. The cardiopulmonary complications of cytarabine are also reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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