Presentation
Developed shortness of breath several hours after receiving several units of platelets.
Patient Data
Previous x-ray, 2 days earlier - lungs are clear.
Lungs show bilateral diffuse coarse reticular pattern and prominent hila.
CT chest-abdomen-pelvis (abdomen and pelvis not included here; no pathology of concern) done shortly after intubation.
Properly placed ETT and NGT.
Paraseptal emphysema, mostly in upper lung lobes.
Repeat chest x-ray:
Right jugular venous catheter with tip in SVC. Properly placed ETT and NGT.
Case Discussion
Was diagnosed with leptospirosis after having complained of weakness and myalgia, without arthralgia. History of COPD due to heavy smoking. During hospitalization, thrombocyte levels dropped to 14K/uL (true thrombocytopenia), probably due to sepsis. Received 6 units of thrombocytes. Approximately two hours later, developed severe shortness of breath.
X-ray chest showed course reticulations. Intubated and ventilated. CT chest-abdomen-pelvis showed diffuse crazy paving; no intra-abdominal pathology of concern.
Since all other parameters remained unchanged (e.g. continued receiving the same antibiotics) except for the thrombocyte infusion, respiratory failure was attributed to transfusion-related acute lung injury (TRALI), for which she received steroids, in addition to the antibiotics and supportive treatment. She was weaned from ventilation after two days and released from the hospital two days later.
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