1/9. Acute respiratory distress syndrome in a welder exposed to metal fumes.A 43-year-old man began having malaise, chills, and fever 12 hours after cutting a galvanized steel grating with an acetylene torch at work. Over the next 72 hours, his symptoms persisted and became worse with progressive shortness of breath. He was admitted to the hospital and begun on antibiotics and steroids. The next day his condition had deteriorated to the point that he had to be intubated. Chest x-ray film and computed tomography showed patchy and interstitial infiltration bilaterally, consistent with acute respiratory distress syndrome. Open lung biopsy showed focal mild interstitial pneumonia. Multiple laboratory studies were negative for an infectious or an immune process. The patient remained on mechanical ventilation for 10 days and was discharged from the hospital 2 days after extubation. He continued to improve, with minimal symptoms and a return to normal activity levels several months after the incident with no continued treatment. Re-creation of his exposure was done under controlled circumstances, with air sampling revealing elevated air levels for cadmium and zinc and borderline levels of arsenic, manganese, lead, and iron.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
2/9. vibrio vulnificus infection complicated by acute respiratory distress syndrome in a child with nephrotic syndrome.A 9-year-old girl with nephrotic syndrome visited a local hospital after developing fever, chills, and edematous changes and multiple hemorrhagic bullae on both legs over 2 days. Cultures of blood and an aspirate from the bullae yielded vibrio vulnificus. The patient was transferred to our hospital because of persistent fever, generalized edema, acute renal failure, and disseminated intravascular coagulopathy. We treated this patient as a V. vulnificus infection complicated with necrotizing fasciitis. With minocycline and ceftazidime combination therapy was instituted. Emergency fasciotomy and continuous peritoneal dialysis were performed. The patient developed acute respiratory distress syndrome (ARDS) during the hospitalization, requiring intubation and mechanical ventilation. She eventually died. The histopathological findings showed diffuse alveolar damage with lobular pneumonitis. Hyaline membranes, composed of proteinaceous exudate and cellular debris, covered the alveolar surfaces. Microscopic examinations of lung could not distinguish the effects of cytolysin from other insults to lungs that occur in ARDS. This report highlights the postmortem pathological findings in V. vulnificus infection in a child with nephrotic syndrome complicated by ARDS.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
3/9. adult respiratory distress syndrome complicating plasmodium falciparum malaria.In people who do not have clinical immunity to malaria, infection with the malaria parasite could lead to severe complications. We describe a patient who had acute and severe lung injury from malaria. A 37-year-old woman had a 24-hour history of generalized weakness and chills 2 days after returning from nigeria. She had received mefloquine as prophylaxis, but the patient did not take the medication. On admission, a thick blood smear revealed severe plasmodium falciparum parasitemia. She was given doxycycline and quinine, but as her parasitemia resolved, dyspnea and hypoxemia developed and she consequently required placement of an endotracheal tube. Chest radiography results showed bilateral and diffuse infiltrate. This report shows that patients with P falciparum malaria should be monitored closely and transferred to an intensive care unit for additional management if respiratory distress develops. physicians caring for patients who have recently traveled to malaria-endemic areas need to anticipate the possible development of malaria with all of its complications, including acute lung injury.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
4/9. Respiratory distress secondary to both amphotericin b deoxycholate and lipid complex formulation.A 73-y-old female with a history of adenocarcinoma of colon and refractory anemia developed febrile neutropenia following chemotherapy. Therapy with iv infusion of amphotericin b deoxycholate (AmBd) was initiated on day 8 of hospital admission. Premedications included acetaminophen, diphenhydramine and meperidine. Patient developed rigor, chill and elevated temperature approximately 100 min into the infusion. The infusion was temporarily discontinued and rigors subsided following administration of 25 mg meperidine im. Infusion was continued after cessation of the rigors with no further sequelae. During each infusion of AmBd over the next 3 d, the patient developed rigor, chill and elevated temperature which was managed with meperidine. However, on day 4 she developed respiratory distress, bronchospasm and visible cyanosis with oxygen saturation of 88% while on 2 L oxygen. The infusion was stopped and the symptoms subsided with administration of albuterol via nebulizer. Amphotericin lipid formulation infusion was reinstituted after 3 d because of the patient's worsening clinical status. However, the patient developed severe respiratory distress approximately 130 min into the infusion. The infusion was discontinued and she was treated with albuterol via nebulizer. itraconazole therapy was instituted without any adverse sequelae. Clinicians should be aware of this potential adverse event since it can occur with all formulation of amphotericin.- - - - - - - - - - ranking = 2keywords = chill (Clic here for more details about this article) |
5/9. Transfusion-related acute lung injury: report of a clinical look-back investigation.CONTEXT: Transfusion-related acute lung injury (TRALI) is a syndrome that includes dyspnea, hypotension, bilateral pulmonary edema, and fever. TRALI is the third leading cause of transfusion-related mortality, but it is probably underdiagnosed and underreported. OBJECTIVE: To determine if blood products from a frequent plasma donor, whose blood product was implicated in a fatal case of TRALI, caused symptoms of TRALI in other recipients of her plasma. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review (conducted from November 2000 through April 2001) of 50 patients who received blood components within 2 years (October 1998 through October 2000) from a donor linked to a transfusion-related fatality. MAIN OUTCOME MEASURE: Occurrence of mild/moderate (dyspnea with fever, chills, hypotension, and/or hypoxemia) or severe (acute pulmonary edema or need for mechanical ventilation) reaction associated with transfusion. RESULTS: Superimposed illness prevented assessment of TRALI in 14 patients. Of the 36 patient charts that could be reviewed, 7 mild/moderate reactions were reported in 6 patients (16.7%) and 8 severe reactions were reported in 8 patients (22.2%). Of 5 patients who received multiple transfusions from the same donor, 2 experienced 2 reactions: one had 2 mild/moderate reactions and the other had both a mild/moderate and a severe reaction. While 5 of the 7 mild/moderate reactions were reported to the hospital transfusion service, only 2 of the 8 severe reactions were reported. Only 2 reactions (1 mild/moderate and 1 severe) were reported to the regional blood collection facility. CONCLUSIONS: TRALI was frequently underdiagnosed and underreported in recipients of blood products from a donor whose blood products may have caused TRALI in several transfusion recipients. Clinical education and awareness of this often-overlooked diagnosis are imperative for appropriate prevention and treatment.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
6/9. Transfusion-related acute lung injury (TRALI).Transfusion is an inevitable event in the life of many individuals. transfusion medicine personnel attempt to provide blood products that will result in a safe and harmless transfusion. However, this is not always possible since no laboratory test gives totally accurate and reliable results all the time and testing in routine transfusion services is devoted primarily to the identification of red blood cell problems. Thus, when patients are transfused, several possible adverse effects may occur in the transfused patient even though quality testing indicates no potential problem. These adverse events include infectious complications, hemolytic reactions, anaphylaxis, urticaria, circulatory overload, transfusion-associated graft-versus-host disease, chills and fever, immunomodulation, and transfusion-related acute lung injury (TRALI).- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
7/9. Histopathology and immunohistologic demonstration of the distribution of rickettsia typhi in fatal murine typhus.An 81-year-old woman had chills, fever, nausea, vomiting, and epigastric pain. On day 3 she had hematuria and was treated with trimethoprim-sulfamethoxazole. On day 5 she had a cough, hypotension, anemia, azotemia, and elevated hepatic enzyme levels. Her condition deteriorated with thrombocytopenia, anuria requiring dialysis, edema, and hypoalbuminemia. Treatment with chloramphenicol and doxycycline was started on day 10. By day 11, she was in hypotensive shock; on day 12 she had seizures and died. Murine typhus was diagnosed by demonstration of antibodies to rickettsia typhi by indirect immunofluorescence. Necropsy revealed interstitial pneumonia, pulmonary edema, hyaline membranes, alveolar hemorrhages, petechiae and vasculitis in the central nervous system, interstitial myocarditis, multifocal interstitial nephritis and hemorrhages, splenomegaly, portal triaditis, and mucosal hemorrhages in urinary tract. Immunofluorescent R. typhi were demonstrated in the lungs, brain, kidneys, liver, and heart. This unusual death occurred in an elderly patient without rash who was treated too late with antirickettsial drugs.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
8/9. Localized fibrous mesothelioma in the postpartum period.The case presented here is typical of the localized fibrous mesotheliomas reviewed in the literature. It had a disastrous impact on an otherwise unremarkable pregnancy. There is no discussion in the literature of humeral factors related to localized fibrous mesotheliomas, but the fever, chills, and rheumatoid complaints in some patients may suggest such factors. The presence of the tumor in the already hypercoagulable state of pregnancy may have predisposed this patient to pulmonary emboli. Anticoagulation led to hemorrhage from the thin-walled vascular areas of the tumor. This acute bleeding produced the hypovolemic shock on the third postpartum day, with a cascade of events leading to adult respiratory distress syndrome and the patient's ultimate death. This case underscores the importance of broad differential diagnosis as a continuing challenge in the practice of medicine.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
9/9. Loxoscelism of the eyelids.Loxoscelism is a reaction to the bite of spiders of the genus Loxosceles. Several species have been found in the united states; the most commonly encountered is L reclusus, the small brown recluse spider. Two types of reactions occur from the bite. In the localized type, necrotic loxoscelism, a cutaneous lesion with extensive gangrene develops. About 25% of patients have systemic manifestations of viscerocutaneous loxoscelism. There is the same local reaction, but, in addition, fever, chills, vomiting, joint pain, and hematologic abnormalities occur. Hemoglobinemia and hemoglobinuria suggest severe involvement. Deaths are believed to be caused by massive intravascular hemolysis. We describe a 61-year-old man who was bitten on the periorbital region; viscerocutaneous loxoscelism with gangrenous involvement of the eyelids developed. Severe laryngeal edema from regional, massive swelling of his neck was life threatening.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |