April 2017 Critical Care Case of the Month
Sunday, April 2, 2017 at 8:01AM
Rick Robbins, M.D. in DRESS syndrome, colchicine, disseminated intravascular coagulation, granulocyte colony stimulating factor, multisystem organ failure, nausea, rash, shock, toxicity, vomiting diarrhea

Robert A. Raschke, MD

Banner University Medical Center-Phoenix

Phoenix, AZ USA

 

History of Present Illness

A 20-year-old woman was transferred from another medical center for care. She was pregnant and initially presented with a one day history of crampy abdominal pain with nausea and vomiting after eating old, bad tasting chicken two days previously. She had pain of her right arm and a non-displaced humeral fracture was seen on x-ray. The etiology of the fracture was unclear. Her illness rapidly progressed to respiratory distress requiring intubation. The fetus had deceleration of heart tones leading to a cesarean section and delivery of a non-viable infant. Subsequently, she had rapid progression of shock and anuria.

Past Medical History

She had a previous history of a seizure disorder which was managed with levetiracetam, clonazepam, and folic acid. There was a previous intentional opiate overdose 2 years earlier. One month prior to admission she had visited her husband in Iraq. After returning to the US 3 weeks prior to admission, she developed a sore throat and was treated with penicillin. She smokes tobacco hookah and marijuana. There is a positive family history of gout.

Physical Examination

Figure 1. Photograph of patient’s back showing rash.

Initial Laboratory Evaluation

Which of the following should be done immediately? (Click on the correct answer to proceed to the second of five pages)

  1. Bedside echocardiography
  2. Liver biopsy
  3. Urine drug screen
  4. 1 and 3
  5. All of the above

Cite as: Raschke RA. April 2017 critical care case of the month. Southwest J Pulm Crit Care. 2017;14(4):134-40. doi: https://doi.org/10.13175/swjpcc039-17 PDF

Article originally appeared on SOUTHWEST JOURNAL of PULMONARY & CRITICAL CARE (http://www.swjpcc.com/).
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