Case Reports in Critical Care最新文献

Gastroesophageal variceal bleeding is a life-threatening complication of portal hypertension in patients with cirrhosis. Endoscopic cyanoacrylate injection is an established therapy for variceal hemorrhage, but it may lead to rare systemic complications, including glue embolization. The authors report the case of a patient with decompensated cirrhosis who developed acute gastroesophageal variceal bleeding, managed with endoscopic variceal ligation and cyanoacrylate injection. Postprocedural investigations revealed multiple emboli involving the cerebral, pulmonary, coronary, and renal vascular territories. The present case report and review of the literature highlight the need for increased awareness of glue embolization as a potential adverse effect of cyanoacrylate therapy. Careful patient selection, refined endoscopic technique, and close postprocedure monitoring are essential to minimizing the risks of embolization, reducing complications and optimizing outcomes.

Purpose: The purpose of the study is to describe the clinical presentation of pregnant women diagnosed with acute respiratory distress syndrome (ARDS) secondary to Listeria monocytogenes infection, complemented by a systematic review of reported cases in the literature.

Materials and methods: A systematic review was conducted in accordance with PRISMA guidelines using major international databases (PubMed, Scopus, Web of Science, Embase, and SciELO) and gray literature sources. Included studies comprised case reports of ARDS associated with microbiologically confirmed gestational listeriosis. Data extraction focused on clinical, laboratory, and imaging variables, as well as maternal-fetal outcomes.

Results: A total of three prior cases of ARDS associated with gestational listeriosis were identified in the literature. Including the present report, four cases were analyzed, with a mean maternal age of 26 years. Three patients were in the third trimester and one in the second trimester. The duration of illness ranged from 3 to 6 days, with all patients presenting with fever and tachypnea; additional symptoms included abdominal pain, nausea, vomiting, chest pain, and dyspnea. Laboratory abnormalities included lymphopenia (244-393 cells/mm³) and thrombocytopenia (56,000-68,000/mm³) in two patients. Three required intensive care monitoring, and two underwent mechanical ventilation. Maternal outcomes were favorable in all cases; however, one fetal death was reported.

Conclusion: ARDS associated with listeriosis during pregnancy is an exceptionally rare but high-risk condition that necessitates early diagnosis and timely intensive care. This study highlights the importance of prompt clinical recognition, appropriate antibiotic therapy with ampicillin, and the potential role of noninvasive oxygenation strategies to avoid intubation in pregnant patients with acute respiratory failure.

Aortic intramural hematoma is a significant presentation of aortic syndromes. It is characterized by bleeding within the aortic media without an intimal defect and can lead to acute aortic dissection if the intimal layer ruptures. Diagnosis requires a high level of suspicion, with CT angiography being essential for confirmation, especially to differentiate it from other conditions. In this case report, we discuss the presentation of an 84-year-old African American female with hypothyroidism and hypertension who presented with chest pain, nausea, and hypertension. Lab tests showed mild lactic acidosis and elevated troponins, with a positive drug screen for amphetamines, and she was diagnosed with acute intramural hematoma as well as pericardial effusion on imaging. Aortic intramural hematoma affects elderly individuals with risk factors for severe atherosclerotic disease. Diagnosis involves imaging studies, particularly noncontrast CT scans, followed by contrast CT scans. The prognosis varies based on the type of intramural hematoma. Further research is needed to guide conservative treatment strategies.

Severe anaphylaxis is an acute allergic reaction that can be life-threatening if not managed rapidly. Its clinical manifestations are diverse, typically including hypotension, respiratory failure, and skin manifestations. However, seizures are an uncommon presentation and may easily be overlooked. We report a case of severe anaphylaxis following intrathecal injection of a contrast agent used in the evaluation of brachial plexus injuries. The initial manifestations were seizures and hypotension, occurring 15 min after injection. The patient survived following appropriate treatment and was subsequently discharged.

A 67-year-old male with hepatocellular carcinoma under lenvatinib therapy suffered from initially back pain and then abdominal pain, dyspnea, and oliguria. Acute type A aortic dissection was diagnosed with point-of-care ultrasound and computed tomography during the admission. Patients treated with vascular endothelial growth factor tyrosine kinase inhibitors (VEGF-TKIs) have a low but significant risk of aortic dissection. As a newer member of VEGF-TKIs, lenvatinib has a similar or even higher risk of aortic dissection compared to others. Clinicians should take the cardiovascular risk into consideration while prescribing lenvatinib and keep the differential diagnosis of aortic dissection in mind during the therapy.

Central venous catheters (CVCs) are commonly placed in patients in critical care units (CCUs) for a variety of reasons. Indications for CVC placement include rapid volume resuscitation, central venous pressure monitoring, venous access in patients with severe vascular disease, hemodialysis, and the need for the administration of vasoactive/bioactive medications. The placement of a CVC, however, does not come without risks to the patient, and one must keep these complications in mind. A 66-year-old male with Stage IV chronic kidney disease was admitted for dehydration secondary to diarrhea and was started on intravenous fluid resuscitation. During his eventful hospital course, the patient was transferred to the CCU, where a right internal jugular CVC was placed with eventual removal. A few minutes after removal, the patient was found to be poorly responsive, diaphoretic, and noted to have neurologic findings. A computed tomography scan of the head and a computed tomography angiogram of the head and neck revealed air within the subarachnoid space, subtle parenchymal hypodensity along the right cerebral cortex, and air inside the jugular and vertebral venous system. Magnetic resonance imaging of the brain revealed air within the cavernous sinuses, cortical veins, and dural sinuses. The patient was treated with aspirin and statin therapy given stroke-like symptoms, with eventual improvement and discharge. Air embolism (AE) is an uncommon and dangerous complication that can result from various reasons, such as trauma, surgery, septal defects, or barotrauma. In this case, the AE was a devastating complication of a CVC. They can occur at various portions of the insertion and removal process. AE may cause cardiopulmonary distress and/or neurologic symptoms. Given the clinical context, a high level of suspicion is required to diagnose cerebral AE. This unfortunate event highlights the dangerous complications of a routine procedure. Early diagnosis and clinical suspicion of AE decrease morbidity and mortality.

Urine discoloration is a frequent clinical observation that often indicates underlying pathological or pharmacological conditions. Pink urine syndrome (PUS) is a rare phenomenon characterized by the sudden appearance of pink-colored urine, typically attributed to the excretion and crystallization of propofol metabolites. Factors such as obesity, dehydration, and critical illness may exacerbate this condition. Although rare, PUS should be considered in critically ill patients receiving propofol sedation in the intensive care setting. This case report describes the occurrence of PUS in a 29-year-old male with a body mass index of 27.31 kg/m², who was sedated with propofol following an overdose. The urine discoloration resolved after discontinuation of propofol and initiation of hydration therapy, emphasizing the importance of early recognition and prompt intervention. While PUS is benign, generally self-limiting, and resolves without specific treatment, careful monitoring is essential to mitigate potential complications due to precipitation of uric acid crystals, such as urolithiasis, obstructive uropathy, and acute kidney injury, if exposure continues.

We present the case of a 58-year-old woman with fibrotic hypersensitivity pneumonitis, without significant comorbidities, who developed posterior reversible encephalopathy syndrome (PRES) 7 days after a bilateral lung transplant. Initial symptoms included hypertension, headache, nausea, vomiting, and cortical blindness. Although no seizures were observed, the electroencephalogram revealed occipital epileptic discharges. Brain magnetic resonance imaging confirmed the diagnosis of PRES, showing a typical pattern of vasogenic edema in the corticosubcortical occipital regions. Tacrolimus was discontinued, and antihypertensives and anticonvulsants were initiated, resulting in complete neurological recovery within 4 days. After 16 days without calcineurin inhibitor, cyclosporine was introduced with no recurrence of the neurological condition.

We report the case of a 37-year-old female patient admitted to our hospital with unstable bradyarrhythmia, abdominal cramping, vomiting and visual disturbances including xanthopsia and diplopia. Ten hours prior to admission, she reported ingestion of four seeds of Cerbera odollam and four crushed nutmegs with suicidal intent. The patient was hypotensive and suffered from hyperkalemia (serum potassium > 5.5 mmol/L), leucocytosis and acute kidney injury. Her heart rate ranged between 28 and 40 bpm, and electrocardiogram (ECG) revealed a second-degree atrioventricular (AV) block and ST-depressions. The patient developed a third-degree AV block requiring vasopressors and transvenous pacing, which she remained completely dependent upon for 56 h. After a total of 3 days, the patient remained hemodynamically stable, and the pacemaker was removed. ECG still featured downsloping ST-depressions, first-degree AV block and sinus bradycardia. The patient survived. Her clinical course was typical and severe. Cerbera odollam poisoning is a potentially fatal condition associated with arrhythmia, abdominal symptoms and electrolyte disturbances. It remains a rarity in Europe and hardly known to Western physicians. Given its potentially lethal effects and increasing availability of its seeds, Cerbera odollam poisoning must be included in the differential diagnosis of unknown intoxications. With this case report, we hope to raise awareness among physicians for Cerbera odollam intoxications in Europe.

Anaphylaxis, the most severe form of allergic reaction, has a prevalence of 1/5000-1/20,000 following general anesthesia. Numerous substances used in anesthesia, such as induction agents and muscle relaxants, can potentially trigger anaphylactic reactions. Muscle relaxants, particularly rocuronium (a nondepolarizing aminosteroid curare), are among the most frequently implicated agents. Anaphylaxis should be suspected when sudden-onset symptoms affecting multiple systems manifest, including typical skin lesions, severe respiratory, cardiovascular, and/or gastrointestinal symptoms. In addition to its well-known symptomatology, anaphylaxis may also induce less well-described alterations in the coagulation system. Although cases of hyperfibrinolysis and disseminated intravascular coagulation have been reported, their incidence and clinical relevance remain unclear. Assessment of potential coagulation disorders related to anaphylaxis should involve both static blood tests specific to the coagulation pathways (e.g., INR, PTT, and fibrinogen) and viscoelastic coagulation tests (e.g., thromboelectography). Here, we present a rare case of a patient who experienced a significant anaphylactic reaction accompanied by hypofibrinogenemia following the administration of rocuronium during general anesthesia.