Tuesday, October 4, 2016

Last Few Cases

Sorry, I was on call yesterday, and Case of the Day totally slipped my mind. Here's a pretty good one on a disease that was on critical care boards. This week is busy for me but I'll put up answers for the last few cases soon.

A patient with leukemia undergoes an autologous hematopoietic stem cell transplant. Two weeks later, she develops a temperature of 38.5C and a maculopapular rash initially concerning for graft-versus-host disease. She feels short of breath, and her room air saturation is only 84%. Review of systems is positive for diarrhea, but stool infectious workup is negative. Chest X ray shows bilateral air-space opacities. Her blood cultures, urinalysis, and sputum are negative; a procalcitonin is normal. A bronchioalveolar lavage is performed which is unremarkable. Her echo does not show heart failure though she does have some edema, weight gain, and ascites. Labs show hypoalbuminemia.

Challenge: What is your diagnosis?

1 comment:

Craig Chen said...

Last Few Cases

This is engraftment syndrome; the pulmonary component is called PERDS or peri-engraftment respiratory distress syndrome. PERDS occurs due to increased pulmonary capillary permeability during the neutrophil recovery phase of bone marrow transplant.

Source: UpToDate.