ABSTRACT
Disseminated intravascular coagulation (DIC) is an acquired syndrome that can lead to catastrophic thrombosis and hemorrhage. In DIC, an uncontrolled release of pro-inflammatory mediators activates tissue factor-dependent coagulation. These changes cause endothelial dysfunction and increased depletion of platelets and clotting factors needed to control bleeding, which results in excessive bleeding. The clinical manifestations are microvascular thrombosis and hemorrhage, which cause severe organ dysfunction and worsening of organ failure. Its clinical management is challenging. Coronavirus disease 2019 (COVID-19) is characterized mainly by respiratory manifestations. In severe cases, however, systemic inflammatory response syndrome can develop with cytokine release that leads to coagulopathy and DIC. Among patients with COVID-19, this complication occurs rarely, leading to death in the majority of cases. We describe the case of a 67-year-old woman with asthma and class 1 obesity, hospitalized with respiratory insufficiency after diagnosis of COVID-19, in whom DIC developed with hemorrhagic manifestations on Day 4 of hospitalization. In spite of poor prognosis and multiple complications throughout the 87 days of hospitalization, including 62 days in the ICU, this patient survived.
ABSTRACT
There is an unclear association between the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and amyotrophic lateral sclerosis (ALS), with few reports in the literature. We report the case of an 80-year-old man admitted to our emergency room with asthenia, dysphonia, dysphagia, weight loss, and euvolemic hyponatremia, indicating a SIADH. Posteriorly, the patient also developed respiratory failure, which, in association with the previous clinical presentation, led to the diagnosis of ALS. During her permanence at the hospital, the hyponatremia improved with noninvasive positive-pressure ventilation, and the association between these two identities was made. This case also shows that patients with ALS commonly suffer from chronic respiratory failure and still have a reserved prognosis.
ABSTRACT
Boerhaave's syndrome is a rare spontaneous perforation of the esophagus with high mortality. The diagnosis is difficult because it has no specific symptom. It requires urgent intervention. We report the case of a 63-year-old male admitted to the emergency department with respiratory distress. Chest computed tomography (CT) revealed large, bilateral, and tension hydropneumothorax, stomach distention, and aerobilia. Thoracic drainage was performed immediately. Control CT revealed esophagus perforation in the middle third of the esophagus with extravasation of the contrast product from the esophagus to the pleura. Urgent surgery was performed, and the patient was admitted to the intensive care unit (ICU) with septic shock. Early diagnosis and management with a damage control approach including thoracic drainage and surgery are essential to improve prognosis and reduce mortality.
ABSTRACT
Favism is an acute hemolytic syndrome that occurs in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency following the ingestion of fava beans. Diagnosis can be challenging because the severity of hemolytic anemia varies among this patient population. Furthermore, the severity of hemolytic episodes can vary in the same patient. The diagnosis of G6PD deficiency and patient education pertaining to safe and unsafe medications and foods are crucial to prevent the reoccurrence of hemolytic episodes. Here, we report the case of a man admitted to our hospital with an acute hemolytic episode. At the time of admission, we were unaware that he had ingested fava beans and only discovered that he had G6PD deficiency while performing complementary studies during the hemolytic crisis to determine its etiology.
