2. HISTORY AND PRESENTATION
• 39 years old male presented to the ER with left sided
chest pain, radiating to the back/left shoulder for 3/7.
• He describes the pain as spasm-like in nature, it was
preceded by history of vigorous physical exercises 2
days, and it worsens with respiration and cough.
• No history of hemoptysis, fever, dizziness, LOC, leg pain
or swelling and history of sick contact or recent travel.
3. • K/C/O DM2 (not compliant to his medications), DLP,
Hypothyroidism, Vitiligo & Alopecia areata
• No Past surgical hx
• Ex-smoker
• Non-drinker
4. PHYSICAL EXAMINATION ON ADMISSION
• Conscious, alert & oriented to TPP
• Tachycardic
• Maintaining oxygen saturation 92% on RA
• Chest: Bilateral expiratory wheezes mid to lower zones, reduced AE over left side
• CVS: N S1+S2+0
• Abd: soft, lax, no tenderness
• No lower limbs edema, Calves soft on palpation, no tenderness
5. INVESTIGATIONS
• WBC 17.3 (NE% 82.6), Hb 12.5, Plt 301, D-Dimer 3.1
• Na 133.9, K 4.69, Cl 94.9, CO2 16.2, RFT NL, Cardiac enzymes NL, Trop-I 0
(repeated set of Trop-I <0.010)
• Ketones 2.7 (was 4.8), BS 13.7 (15.4)
• VBG PH 7.397 PCO2 33.3 HCO3 20 BE -3.5
• ECG sinus tachycardia
• CXR was done
16. COURSE
• High Resolution CT Chest(10/10) : Significant decrease in the previously
seen left pleural effusion volume with mild residual/insisted
appearance.
• On (10/10) ECHO was done showing mild to moderate pericardial
effusion
• The patient management kept the same, draining and monitoring
inflammatory markers and the patient was stable until (20/10)
24. COURSE CHANGE (FIRST TWIST) MICROBIOLOGY
• Plural drain was positive for Ochrobactrum anthropi and vancomycin started but
after 2 days the level was 34 so it was discontinued
• Inflammatory markers (CRP230, PCT 63.9) and RFT (Cr 811) started to raise on
(21/10) chest drain was removed
• The patient started become hypotensive and was complaining of severe back pain
and Lt. sided groin pain. Antibiotics upgraded to Meropenem 1g, ICU review was
done
• What is your impression so far?
40. • On (22/10) CT was performed for this pain showing Lt sided retroperitoneal
hematoma
• IR Procedure done (23/10/23): Selective left lumbar angiography shows contrast
extravasation from L2/3 lumbar artery. Embolization done with particles 300-500U
and one coil 4mm. Bleeding stopped. The right CFA access closed with angioseal.
49. • On (6/11) patient was discharged from the ICU
• Kept on Linezolid 27/10 to 15/11/2023 until inflammatory markers and
RFT normalized
• CVP removed on (12/11) - Dialysis Catheter removed on (14/11)
• Patient was discharged on (16/11)