Indian Journal of Critical Care Case Report

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2023 | November-December | Volume 2 | Issue 6

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From the Editor's Desk

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/ijccr-2-6-v  |  Open Access | 



R Bharatram, Alexander Kuruvilla, Dhayashri Dhavapalani, Balaji Rajaram

A Patient with Pulmonary Embolism: A Story of Unfortunate Events

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:6] [Pages No:149 - 154]

Keywords: Cardiac arrest, Hemodynamic collapse, Pulmonary embolism

   DOI: 10.5005/jp-journals-11006-0091  |  Open Access |  How to cite  | 


Manifestations of pulmonary embolism (PE) can range from an incidental diagnosis in an otherwise asymptomatic patient to hemodynamic collapse and sudden death. In the later presentation, the diagnosis, initial management, and the subsequent devastating complications arising from the condition and its treatment presents unique challenges necessitating complex decision-making. Multidisciplinary involvement with balanced decision-making weighing the risks and benefits involved at every step is the key to successful management and achieving optimal outcomes.



Shailendra Singh

Thyroid Storm Associated with COVID-19 and Complicated with Diabetic Ketoacidosis: A Case Report

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:3] [Pages No:155 - 157]

Keywords: Case report, Coronavirus disease 2019, Diabetic ketoacidosis, Thyroid medications, Thyroid storm

   DOI: 10.5005/jp-journals-11006-0087  |  Open Access |  How to cite  | 


Thyroid storm (TS) is a rare, life-threatening health condition associated with undertreated hyperthyroidism. During a TS, individual vitals can soar to dangerously high levels, and without prompt, aggressive management, a TS can be fatal. Diabetic ketoacidosis (DKA) is a trigger for thyroid crisis. However, TS and DKA rarely occur simultaneously. Here, we are presenting a case of TS having coronavirus disease 2019 (COVID-19) at admission, complicated with DKA. However, it has been seen that TSs can precipitate DKA in a few instances. Case description: A 72-year-old female with a history of diabetes mellitus (DM) was brought to the emergency room with symptoms of recurrent DKA. She was COVID-19-positive at the time of admission but with minimal upper respiratory symptoms. DKA protocol was started according to our hospital policy, but she developed tachycardia, a high fever, and a disturbing level of consciousness. After laboratory investigations revealed disturbing thyroid functions. So, DKA with TS was diagnosed. Antithyroid medication, inorganic iodine, and corticosteroids were then started as a treatment for TS, and β-blockers were administered to manage tachycardia. With these treatments, the patient's health improved, and she recovered. Conclusion: In severe cases of DKA, sometimes the presence of TS can be considered, and early treatment should be initiated before the patient's condition worsens.



Bhavinkumar Patel, Purvesh Umraniya, Rachana Patel, Dharmesh Patel, Haresh Shah, Atul Jani, Vikas Dosi, Manish Mittal, VC Chauhan, Kilol Kaneria, Chinmay Pathak, Gaurav Malviya, Jigna Parmar, Yogesh Parmar, Maksud Shaikh, Lubna Shaikh

Right Ventricle Thrombus and COVID-19 Infection: An Uncommon Report of Three Cases

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:3] [Pages No:158 - 160]

Keywords: Coronavirus disease 2019, Coronavirus, Right ventricle thrombus, Severe acute respiratory syndrome coronavirus 2, Thrombotic

   DOI: 10.5005/jp-journals-11006-0079  |  Open Access |  How to cite  | 


A report of three patients with severe coronavirus disease 2019 (COVID-19) infection and right ventricle thrombus is being presented. All of them were thrombolyzed, out of which two patients survived. Based on various studies and supporting our case series, we advocate a low threshold of 2D-echocardiogram (2D-echo) screening, especially in those patients having disproportionate oxygen requirements. More studies are required to prove that early thrombolysis may be beneficial in COVID-19 patients with right ventricular thrombus (RVT).



Baijaeek Sain, Sukhmani Kaur, Ananya Veenarun, Avik Roy, Ritam Chakraborty, Arpit K Saha

Central Pontine Myelinolysis with Extrapontine Involvement in a Case of Chronic Alcoholism without Dysnatremia

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:4] [Pages No:161 - 164]

Keywords: Alcohol, Case report, Central pontine myelinosis, Dyselectrolytemia

   DOI: 10.5005/jp-journals-11006-0077  |  Open Access |  How to cite  | 


Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are osmotic demyelination syndromes (ODS) that are predominantly found in malnourished and chronically alcoholic patients. The clinical presentation of ODS varies depending on the affected area of the brain lesion and ranges from mild tremor to locked-in syndrome, pseudobulbar palsy, encephalopathy, and paralysis. Although we frequently see patients with alcohol dependence syndrome complicated by withdrawal, CPM remains largely undetected and underreported in the literature. We describe here a chronic alcoholic patient who suffered from ODS without hypo/hypernatremia during alcohol withdrawal and eventually showed neurological recovery.



Shivnath Dudala, Shashidhar Pulgam

Massive Hepatic Infarct in a Patient with Eclampsia: A Rare Case Report

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:3] [Pages No:165 - 167]

Keywords: Case report, Computed tomograph, Eclampsia, Gestational hypertension, Hemolysis, elevated liver enzymes, and low platelets syndrome, Massive hepatic infarction

   DOI: 10.5005/jp-journals-11006-0080  |  Open Access |  How to cite  | 


Hepatic infarction is rare due to the unique dual hepatic blood supply from the hepatic artery and the portal vein. Here, we report a case of massive hepatic infarction that occurred as a complication of eclampsia followed by hemolysis, elevated liver enzymes, and low platelets (HELLP). A 30-year-old G2P1D1 female patient of 32 weeks gestation with gestational hypertension (diagnosed at 24 weeks of gestation) presented to the ER with low backache, pedal edema, and generalized tonic-clonic seizure (GTCS) lasting for 30 seconds. This patient was diagnosed with eclampsia followed by HELLP, which was further complicated by massive hepatic infarction, and was diagnosed with computed tomography (CT) of the abdomen and pelvis.



Deven Juneja, Omender Singh, Joy D Mukherji, Rahul Grover, Tarun Sharma

Life-threatening Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus and Antiphospholipid Syndrome

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:4] [Pages No:168 - 171]

Keywords: Alveolar hemorrhage, Antiphospholipid antibodies, Antiphospholipid syndrome, Case report, Pulmonary hemorrhage, Rituximab, Systemic lupus erythematosus

   DOI: 10.5005/jp-journals-11006-0082  |  Open Access |  How to cite  | 


Introduction: Autoimmune diseases may have myriad presentations and may sometimes present with life-threatening systemic complications. Here, we present a case who presented with massive hemoptysis and was diagnosed to have systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome (APS) and diffuse alveolar hemorrhage (DAH). Case description: A 45-year-old female, a known case of hypertension and seizure disorder, presented with a 1-day history of breathlessness and hemoptysis. She required intubation and invasive mechanical ventilation in view of massive hemoptysis and high oxygen requirement. Subsequent investigations confirmed the diagnosis of SLE with secondary APS and DAH, and she was treated with pulse dose corticosteroids and rituximab with a favorable outcome. Conclusion: SLE and APS may rarely present with bleeding complications like DAH. Hence, a high index of suspicion must be kept as early therapy with immunosuppressants like high-dose corticosteroids and rituximab may lead to good clinical outcomes.



Ranjana Venkatachalapathy, Ganshyam Jagathkar, Chandreshkumar Sudani

HIT Syndrome Complicating Severe ARDS Requiring VV ECMO: A Case Report

[Year:2023] [Month:November-December] [Volume:2] [Number:6] [Pages:4] [Pages No:172 - 175]

Keywords: Acute respiratory distress syndrome, Case report, Extracorporeal membrane oxygenation, Heparin-induced thrombocytopenia

   DOI: 10.5005/jp-journals-11006-0086  |  Open Access |  How to cite  | 


Background: Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention for patients with refractory respiratory failure and/or shock and can be provided via a venovenous (VV) or venoarterial (VA) circuit. Application of ECMO exposes the patient to a number of complications ranging from hemorrhage to infection. Thrombocytopenia is one such complication. Due to the need for systemic anticoagulation with unfractionated heparin (UFH), those treated with ECMO may be at risk for heparin-induced thrombocytopenia (HIT). Incidence of HIT in ECMO is <1%. Being a rare entity, HIT syndrome in ECMO presents as a unique diagnostic and therapeutic challenge. Case description: A 45-year-old male, a known smoker, presented to the hospital with complaints of fever and cough for 1 week and grade 4 breathlessness for 1 day. He was diagnosed as acute respiratory distress syndrome (ARDS) with H1N1 positive, and treatment was initiated accordingly. However, during the course of his stay in the intensive care unit (ICU), his oxygenation worsened. He was upgraded to high-flow nasal cannula (HFNC) support but had to be eventually intubated and mechanically ventilated as his respiratory mechanics were not improving. In view of refractory hypoxemia, VV ECMO was initiated with heparin infusion on flow. Initially, an improvement in oxygenation was witnessed, but 2 days post initiation of ECMO, complications raised in the form of thrombocytopenia, recurrent oxygenator failure (clotting), and deep vein thrombosis (DVT) of the right femoral vein. Even though initial suspicion was of sepsis-induced thrombocytopenia, the presence of thrombosis with 4T score of 7 strongly favored HIT syndrome, and diagnosis was confirmed by laboratory testing. Immediately, the circuit and oxygenator were changed, and heparin infusion was replaced with bivalirudin infusion. The patient developed ventilator-associated pneumonia as well as transfusion-related acute lung injury (TRALI) due to multiple transfusions. Antibiotics were escalated accordingly, and he underwent tracheostomy, anticipating prolonged ventilator period. Slowly, his oxygenation improved. After 28 days of VV ECMO, he was weaned off the ventilator and ECMO and was discharged home. Conclusion: The challenges faced in this case drive home the fact that HIT syndrome must be the first among the differentials when a patient on ECMO develops thrombocytopenia, and the timely diagnosis and management of HIT are very crucial for a good outcome.


journal videos

A repeat 2D-echo suggested RVT

Right Ventricle Thrombus and COVID-19 Infection: An Uncommon Report of Three Cases

Size: 2 MB

2D-echo was repeated again

Right Ventricle Thrombus and COVID-19 Infection: An Uncommon Report of Three Cases

Size: 13 MB

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