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Southwest Pulmonary and Critical Care Fellowships
Tuesday
Oct012024

October 2024 Critical Care Case of the Month: Respiratory Failure in a Patient with Ulcerative Colitis

Lewis J. Wesselius MD

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?

  1. There is a left lower lobe consolidation.
  2. The portable chest X-ray may be normal.
  3. A chest CT scan is required to definitely view any consolidation.
  4. There is a right upper lobe consolidation.
  5. All of the above.
Cite as: Wesselius LJ. October 2024 Critical Care Case of the Month: Respiratory Failure in a Patient with Ulcerative Colitis. Southwest J Pulm Crit Care Sleep. 2024;29(4):30-33. doi: https://doi.org/10.13175/swjpcc2046-24 PDF

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