Case (sickle cell disease)

Case 1 (sickle cell disease)

A 24-year-old black male presents to the ED complaining of fever, chills, and dyspnea. He has chest pain that is respirophasic (pleuritic) in nature. He is noted to be tachypneic with a respiratory rate of 36 and an oxygen saturation of 90%. He has a history of sicklecell anemia and has had a number of sickle-cell crises in the past. He is up to date on immunizations, including S. pneumonia and Haemophilus influenzae
vaccines.

The patient’s current symptoms are MOST suggestive of:
A) Pneumothorax.
B) Pulmonary embolism.
C) Acute chest syndrome.
D) Sickle cell-related pericarditis.

DiscussionThe correct answer is C. This patient likely has acute chest syndrome, which is associated with sickle-cell anemia and may be indistinguishable from pneumonia. Acute chest syndrome is characterized by pleuritic chest pain, fever, cough, chills, dyspnea, rales, and rhonchi. The etiology is unknown but it may be secondary to infarction of the lung and/or fat emboli.