Asthmatic patient felt down on the ground from Roof

[JNUS]

I thought it would be good to share this interesting case Adapted from TV serial House Season 2, Episode 3

Asthmatic patient was working on the roof, and then he felt down on the ground
They took him to the hospital
His right 2 little fingers were blue in color
They suspect DIC or any clots
They did MRI, complete blood work
Start the patient on heparin
After that his 3rd finger start to be blue

So they think heparin is not strong enough, they start him on activated protein C (which is stronger than heparin but it is just indicated in sever sepsis cases and have high risk of internal bleeding)

Suddenly patient could not move his right hand (due to internal bleeding in the brain as a side effect of the protein C)
They stopped the medication
And did surgery to evacuate the bleeding
After that right arm improved (but still the fingers blue)
In chest x-ray there was infiltrate, and patient have spiky fever
So they thought of asprgillosis pneumonia (they found it in his house)
So they start him on amphoticrin
Next day, patient told them he did not pass urine
So his kidneys shut down as a side effect of amphoticrin. They stopped this medication
Also at the same time blood culture result came –ve for asrgillosis
But the hand getting worse
Gangrene is spreading
So they amputate his right hand (till wrist joint) to prevent spreading
During surgery they noticed even his left little finger start to be blue

Now post op
Patient needs dialysis for his kidney problem
His 02sat is 88% so he needs mechanical ventilation

After thinking
Doctor house said
It is endocarditis
But investigation was –ve
So whats the organism that causes (pneumonia and –ve culture endocarditis)

It was Psittacosis (Chlamydia psittaci)
even his DIC (which causes the blue fingers) dut to Psittacosis

So got his infection from chickens

And his asthma made him more weak than other people

So they start him on the right medication
Patient now good, for discharge but after he lost his right hand

Workers exposed to pigeons, parrots, parakeets, and turkeys are at risk for psittacosis, a lung disease caused by the bacteria Chlamydia psittaci

LEARN MORE FROM eMedicine - Psittacosis : Article by Klaus-Dieter Lessnau, MD, FCCP