A 20-year-old non-smoking young man with autistic disorder and homozygous sickle cell disease (SCD) was referred to the Emergency Department of our hospital for excruciating pain in the back and the right knee. The symptoms had begun six days before with fever that was treated with amoxicillin and ibuprofen.

Examination

Initial physical examination and Chest-X-ray (CXR) were normal. The patient was admitted to the Department of Internal Medicine with a diagnosis of vaso-occlusive crisis, and multimodal analgesia was started.

Three days later, the patient became dyspnoeic and febrile. Physical exam revealed pulmonary bilateral basal crackles with tubular sounds. Oxygen saturation dropped down to 93% on 6 L/min oxygen, with a corresponding PaO2 of 84 mm Hg. CXR revealed bilateral alveolar consolidation with left lung &#39;white out&#39; (Fig. 1-a). The patient was admitted to the ICU and received empirical antimicrobial therapy combining cefotaxime and spiramycin. As the condition of the patient allowed it, a fiberoptic flexible bronchoscopy (FOB) was performed under high-flow nasal cannula oxygen therapy (FiO2 = 1) with a Remifentanil target-controlled infusion

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MediSage Case Discussions

Explore a case of vaso-occlusive crisis in a young man with sickle cell disease, including symptoms, treatment, and ICU management.

Vaso-Occlusive Crisis in Sickle Cell Disease

Sickle cell disease, back pain and fever

Clinical case discussion shared for educational purposes and professional medical opinion.

Sickle cell disease, back...