Dyspnea with hemoglobin SC disease.

BUMC PROCEEDINGS 2002;15:86–90 CASE PRESENTATION LINDA S. BANG, MD: A 41-year-old African American woman with sickle cell disease presented to the Baylor University Medical Center emergency department with dyspnea and dry cough for 3 weeks and back, leg, and chest pain for 2 to 3 days. The hemoglobin SC disease had been first diagnosed during pregnancy. Pleural tuberculosis with a left-sided effusion had been diagnosed 2 years earlier, and she had been treated with 4 antituberculosis medications. She also had had kidney stones and gallstones in the past. Her only operation was a hernia repair at age 38. Medications included rofecoxib, amitriptyline, and a recently completed 10-day course of trimethoprim and sulfamethoxazole for presumed tuberculous pleuritis. She worked for a laboratory, was separated, and had one daughter, who was well. She smoked about 10 cigarettes a day, drank alcohol occasionally, and denied intravenous drug use. In the emergency department, her temperature was 97.4°F (36.4°C); heart rate, 121 beats per minute; respirations, 24 breaths per minute; and blood pressure, 110/80 mm Hg. Oxygen saturation was 87% on room air and 95% on oxygen via nasal canula. The pupils were equal and reactive to light. She had no precordial murmurs, rubs, or gallops. The lungs were clear to auscultation. No abdominal abnormalities were noted. The extremities showed no clubbing, cyanosis, or edema. The patient was alert and oriented with no focal deficits. Results of laboratory tests ordered in the emergency department are summarized in the Table. After treatment with supplemental oxygen, intravenous fluids, and ketorolac tromethamine, the patient felt better and had decreased dyspnea and pain. When she walked, her oxygen saturation fell to 88%, and she became dyspneic, restless, and agitated and had a tonic-clonic seizure. She was given lorazepam and 100% oxygen via nonrebreathing mask; she soon became bradycardic, diaphoretic, apneic, and pulseless. Cardiopulmonary resuscitation was initiated and she was intubated. Approximately 10 minutes later, heartbeats returned, and she was transferred to the coronary care unit. Her blood pressure was 127/77 mm Hg, her heart rate was 112 beats per minute, and she was unresponsive and intubated. The pupils were reactive, the neck was supple, and she had jugular venous distention to the angle of the jaw. She had a right parasternal lift and bilateral pulmonary wheezes. The abdomen was soft and slightly distended. The bowel sounds were normal. The extremities were cool but pedal pulses were satisfactory. Dyspnea with hemoglobin SC disease