Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
October 2024 Critical Care Case of the Month: Respiratory Failure in a Patient with Ulcerative Colitis
Pulmonary Department
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
The patient is a 57-year-old woman with a history of ulcerative colitis (UC) complicated by toxic megacolon with subsequent colectomy. She presented to the emergency department with cough, shortness of breath and hypoxemia (87% on RA).
PMH, SH
- UC with history of toxic megacolon (4 years prior) with a total colectomy.
- History of a prior episode of respiratory failure a year earlier thought possibly medication-induced (ustekinumab, Stelara®) which she was taking for her UC. She was treated with steroids with a good response.
- Pyoderma gangrenosum of both ankles (attributed to UC).
- Anemia of chronic disease.
- She is a lifelong non-smoker.
- No exposures to toxic dusts, birds, down, humidifiers, mold or other antigens associated with hypersensitivity pneumonitis.
Physical Exam
- Afebrile, Oxygen saturation 94% on 2 lpm supplemental oxygen.
- Chest: crackles noted at left base.
- CV regular rhythm, no murmur.
- Ext: scarring and erythema on both ankles consistent with resolving pyoderma gangrenosum.
Current Medications
- Clonazepam 1.0 mg daily at bedtime
- Gabapentin 300 mg TID
- Pantoprazole 40 mg BID
- Prednisone 5 mg daily
Laboratory
- Hgb 9.7, WBC 16.9
- Swabs for Influenza A/B and Covid were negative
- Cocci serology negative
A chest radiograph was performed (Figure 1).
Figure 1. Portable chest X-ray performed in the emergency department. (To view Figure 1 in a separate, enlarged window click here).
Which of the following is/are true regarding the chest X-ray?
- There is a left lower lobe consolidation.
- The portable chest X-ray may be normal.
- A chest CT scan is required to definitely view any consolidation.
- There is a right upper lobe consolidation.
- All of the above.