Case presentation
A 32-year-old female presented to emergency department with respiratory
complaints. She reported repeated chest pain and mild dyspnea. Her
medical history involves TS, Hypertension, and chronic kidney disease,
which requires dialysis three times per week. Her stature is short and
her chest is broad, which is consistent with TS. On physical
examination, orthopnea and bilateral fine crackles has been noticed.
Room air oxygen saturation was low. COVID-19 has been excluded after
doing PCR test. She was admitted in intensive care unit due to unstable
overall condition.
Initial blood works showed markedly elevated white blood cells (15.17
109/L) with neutrophils dominance (77.6%), Hemoglobin (9.6 g/dL),
Hematocrit (28.3%), CRP (93 mg/L), and LDH (809 U/L). Other tests have
been done including: Procalcitonin (11.5 ng/ml), IL-6 (62.3 ng/ml), and
D-Dimer (7.31 ng/ml). Urea, Creatinine, and electrolytes are usually
mildly elevated before dialysis. Tuberculosis has been excluded by
Gene-Xpert.
Chest X-ray revealed bilateral peripheral infiltrations and ground glass
opacities[Figure 1]. Infective pneumonia with hypoxia was the
initial diagnosis. Also, a high anion gap metabolic acidosis was
complicating her case. Later, a CT scan was ordered and revealed clear
signs of bilateral bronchiectasis[Figure 2]. An echocardiogram
showed slight left ventricular hypertrophy, unsignificant right atrial
enlargement, and no coarctation of the aorta.
During her stay in the intensive care unit, she has been treated with
broad-spectrum antibiotics, as ceteriaxone and metronidazole,
non-invasive oxygen therapy, and repeated dialysis. She had a slow
recovery process. Despite that, she has finally showed signs of clinical
improvement and was discharged without any need of oxygen
supplementation or bronchodilators.