Fatal haemolytic crisis with microvascular pulmonary obstruction mimicking a pulmonary embolism in a young African man with glucose-6-phosphate dehydrogenase deficiency

BMJ Case Rep. 2014 Apr 8;2014:bcr2013201432. doi: 10.1136/bcr-2013-201432.

Abstract

We report a fatal case of haemolytic crisis mimicking a pulmonary embolism in a previously healthy 42-year-old African man. The patient was admitted to hospital with fatigue, shortness of breath and jaundice lasting for 2 days. Laboratory tests were consistent with haemolysis and inflammation. The patient was treated as having a mycoplasma pneumonia. His condition deteriorated rapidly, with respiratory distress and circulatory failure. Echocardiography showed pulmonary hypertension and right heart dilation. Despite the fact that he was given fibrinolysis for suspected pulmonary embolism, he developed cardiac arrest and died after a long-lasting resuscitation attempt. Postmortem examinations revealed that the patient had a glucose-6-phosphate dehydrogenase deficiency and disseminated intravascular coagulation with pulmonary microthrombi. To the best of our knowledge, this is the first case of death caused by right heart failure due to microvascular obstruction resulting from multiple microvascular thrombosis in a patient with acute haemolysis due to glucose-6-phosphate dehydrogenase deficiency.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Africa
  • Diagnosis, Differential
  • Fatal Outcome
  • Glucosephosphate Dehydrogenase Deficiency / complications*
  • Hemolysis*
  • Humans
  • Lung Diseases, Obstructive / complications*
  • Lung Diseases, Obstructive / diagnosis*
  • Male
  • Microvessels
  • Pulmonary Embolism / complications*
  • Pulmonary Embolism / diagnosis*