[Acute pulmonary syndrome and cavernous pulmonary tuberculosis in a patient with sickle cell disease].
METHODS
A 17-year-old girl from Zaire was admitted to hospital with fever, cough, dyspnoea and severe chest pain. In addition to marked anaemia (haemoglobin 6.6 g/dl) she was known to have cavitary/exudative pulmonary tuberculosis (PTb) with bilateral basal infiltrations.


METHODS
Blood gas analysis indicated partial respiratory failure (pO2 55 mm Hg, pCO2 36 mm Hg). Blood smear under air exclusion showed erythrocyte sickling. Haemoglobin electrophoresis demonstrated 92.7% HbS and thus confirmed sickle cell anaemia. A small spleen on sonography and the presence of Howell-Jolly bodies were interpreted as signs of functional asplenia. Microbiological and radiological tests confirmed exudative-cavitary PTb.


METHODS
The findings were interpreted as due to an acute chest syndrome, caused by sickle cell thrombi in the pulmonary blood vessels, precipitated by the PTb. Transfusion of two units of erythrocyte concentrates led to improvement of the chest pain and the respiratory failure within a few hours. The PTb was successfully treated without any complications.


CONCLUSIONS
Acute chest syndrome is a vascular occlusive complication of sickle cell disease, pulmonary tuberculosis precipitating the development of this acute condition. Administration of erythrocyte concentrate rapidly improves the signs and symptoms.
Riehl
J
J
Medizinische Klinik II, Klinikums der Rheinisch-Westfälischen Technischen Hochschule Aachen.
Schmitt
H
H
Bergmann
D
D
Fritz
A
A
Sieberth
H G
HG
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D001784:Blood Gas Analysis; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D003371:Cough; D015023:Democratic Republic of the Congo / Q000208:ethnology; D004417:Dyspnea; D017707:Erythrocyte Transfusion; D005260:Female; D005334:Fever; D005858:Germany; D006444:Hemoglobin C / Q000032:analysis; D006801:Humans; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D013154:Spleen / Q000000981:diagnostic imaging / Q000473:pathology; D013577:Syndrome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000628:therapy; D014463:Ultrasonography
D006444:Hemoglobin C
Akutes pulmonales Syndrom und kavernöse Lungentuberkulose bei Sichelzellkrankheit.