Raaijmakers N J, Bokma A H F, Eggen G G, Prins G, Alsma J
Department of Internal Medicine, Erasmus University Medical Center, the Netherlands.
Neth J Med. 2020 Jul;78(4):202-205.
We present a case of a patient with a chronic carbon monoxide (CO) intoxication with facial plethora due to secondary erythrocytosis.
A 22-year-old male was referred by the dermatologist to our outpatient clinic for evaluation of polycythaemia. Laboratory results showed secondary erythrocytosis. After an extensive diagnostic evaluation, we diagnosed a chronic CO intoxication (carboxyhaemoglobin (COHb) level of 21%) without apparent complaints and facial plethora as the only clinical sign. The patient denied smoking tobacco or use of illicit drugs. On inspection of his house by the fire department, a waterpipe was found in his bedroom, which he used daily, according to his father. CO measurements in the house were normal. We treated the patient with high flow oxygen and advised him to quit smoking the waterpipe. Within a few weeks, the erythrocytosis normalised.
We propose to test for the presence of an elevated COHb in all patients with a normal or high erythropoietin level. The test is not expensive and can easily be included as part of an examination, since CO intoxication has potentially disastrous consequences, and, as is illustrated with this case, chronic CO poisoning can be virtually asymptomatic. Not all individuals consider smoking a waterpipe the same as smoking or drugs, and therefore physicians need to specifically ask for its use.
我们报告一例因继发性红细胞增多症导致慢性一氧化碳（CO）中毒且面部充血的患者。
一名22岁男性被皮肤科医生转诊至我们的门诊，以评估红细胞增多症。实验室检查结果显示为继发性红细胞增多症。经过全面的诊断评估，我们诊断为慢性CO中毒（碳氧血红蛋白（COHb）水平为21%），患者无明显不适，唯一的临床体征是面部充血。患者否认吸烟或使用非法药物。据其父亲称，消防部门检查其住所时，在他的卧室发现了一根水烟管，他每天都使用。室内的CO测量结果正常。我们对患者进行了高流量吸氧治疗，并建议他戒烟斗。几周内，红细胞增多症恢复正常。
我们建议对所有促红细胞生成素水平正常或升高的患者检测是否存在COHb升高。该检测费用不高，且可轻松纳入检查项目，因为CO中毒可能会带来灾难性后果，而且，如本病例所示，慢性CO中毒实际上可能没有症状。并非所有人都认为吸水烟与吸烟或吸毒一样，因此医生需要特别询问患者是否使用过水烟。
