Department of Internal Medicine, University of CT Health Center, Farmington, CT.
Division of Pulmonary & Critical Care Medicine, University of CT Health Center, Farmington, CT.
Chest. 2020 Jul;158(1):e21-e24. doi: 10.1016/j.chest.2020.02.034. Epub 2020 Jul 2.
A 57-year-old woman with a history of mantle cell lymphoma presented to the ED with complaints of vomiting, bleeding per rectum, and leg cramps, that started 6 h prior to her arrival. She had received chemotherapy a week prior. Her leg cramps were not associated with pain or swelling of the legs; she also denied any trauma to the legs. She did complain of mild lower abdominal pain at presentation. Review of systems was negative for fever, chills, diarrhea, chest pain, and dizziness. She denied using alcohol or nonsteroidal anti-inflammatory drugs. The patient was tachycardic with a systolic BP (SBP) of 85 mm Hg and was administered 1-L normal saline, with improvement in her SBP to 90 mm Hg. The hematocrit level was 24%, the WBC count was 0.3 × 10/L, and the platelet count was 6 × 10/L in the ED. On arrival in the ICU, she was noted to have an SBP of 70 mm Hg. Resuscitation with IV fluids was initiated, followed by transfusion of packed RBCs and platelets, based on the blood counts. Despite aggressive fluid resuscitation and improvement in her hemoglobin, the patient remained persistently hypotensive. The diagnosis of underlying septic shock because of neutropenia was considered; the patient was started on vasopressors and empirical broad-spectrum antibiotics, with improvement in her BP. After this, the patient was sent to radiology for a CT scan of the abdomen and pelvis with contrast to evaluate for mesenteric infarction, enteric or colonic bleeding, and the need for arterial embolization.
一位 57 岁的女性，患有套细胞淋巴瘤，因呕吐、直肠出血和腿部痉挛到急诊科就诊，这些症状始于她到达前 6 小时。她在一周前接受了化疗。她的腿部痉挛与腿部疼痛或肿胀无关；她也否认腿部有任何外伤。她在就诊时确实主诉有轻度下腹痛。系统回顾无发热、寒战、腹泻、胸痛和头晕。她否认饮酒或使用非甾体抗炎药。患者心动过速，收缩压（SBP）为 85mmHg，并给予 1L 生理盐水，SBP 改善至 90mmHg。入院时，血细胞比容为 24%，白细胞计数为 0.3×10/L，血小板计数为 6×10/L。在 ICU 到达时，她的 SBP 为 70mmHg。根据血细胞计数开始进行静脉补液复苏，随后输注红细胞和血小板。尽管进行了积极的液体复苏和血红蛋白水平的改善，但患者仍然持续低血压。考虑到中性粒细胞减少导致潜在的败血症性休克的诊断；患者开始使用血管加压素和经验性广谱抗生素，血压有所改善。在这之后，患者被送往放射科进行腹部和骨盆 CT 扫描加对比，以评估肠系膜梗死、肠内或结肠出血以及是否需要动脉栓塞。
