Negative pressure pulmonary oedema due to rigors and chills associated with liver abscess

Negative pressure pulmonary oedema (NPPE) is caused by upper airway obstruction and rapid negative pressure due to inspiratory efforts against an obstruction in a patient with preserved ejection fraction. NPPE is a perioperative life-threatening emergency, but it is rarely diagnosed and reported due to unfamiliarity. Here, we discuss the case of a patient who developed acute respiratory failure with bacteraemia due to NPPE after an intense inspiratory effort against transient laryngeal dyskinesia. AbstractA 61-year-old male presented with progressive generalized weakness, myalgia, diaphoresis, fever, episodic chills and rigors that had started 4  days previously. Chest x-ray (CXR) showed overlying curvilinear radio-opacities. Abdominal computed tomography revealed liver and bilateral adrenal lesions. Empiric 7-day intravenous Piperacillin / Tazobactam (Zosyn) was initiated, and he was admitted for sepsis. After an episode of rigors on Day 2, he developed acute hypoxic respiratory failure with inspiratory stridor. CXR revealed new, bilateral airspace disease. Racemic Epinephrine, Solumedrol, Ketorolac (Toradol) and Diphenhydramine were given, and he was transferred to the intensive care unit with presumptive diagnosis of foreign body aspiration or allergic reaction. With each subsequent episode of rigor and chills, he continued developing hypoxic respiratory failure with stridor and an incremental increase in pulmonary oedema on imaging. Pulmonologist concluded it likely sec...
Source: Respirology Case Reports - Category: Respiratory Medicine Authors: Tags: CASE REPORT Source Type: research