Transcript Interesting Case Rounds

Interesting Case Rounds
Meira Louis
PGY 3
August 18, 2011
With thanks to Val Dias of Calgary Lab Services
Triage Note
PANIC ATTACK CO OF FACIAL PAIN.
AND SWELLING TO LT EYE, CO OF NOT
BREATHING. SPO2 100%
HYPERVENTILATING –
Initial Presentation
Nursing Note:
“Was at dentist ~2 months ago. Treated with abx
– “lost them” – c/o pain in L chest & L
shoulder. Dramatic presentation, writhing on
bed.”
EKG
Two separate issues..
• Chest pain
• infection
Why Levamisole?
Effects of Levamisole: neutropenia
CMAJ. January 2010.
Annals of Haem. 2011
Clinical Rheum. 2011.
What about Aminorex?
Back to our case
• What are you going to do with your writhing
patient?
• What investigations do you want?
• What is her disposition?
• Her CBC over the next few days
6
5
Neutrophils
WBC
4
3
2
1
0
1
2
3
4
5
6
Summary
1. Levamisole is now very common in our
population.
2. In certain people it can cause neutropenia and
vasculitis.
3. If you want to test, need a comprehensive urine
drug screen ASAP.
4. Treatment is generally supportive.
5. Watch out for the possibility of pulmonary
hypertension coming to a cocaine addict near you.