A Hospitalized Patient With Systemic Scleroderma Requiring ICU-Level Care

A patient with a history of systemic scleroderma complicated by interstitial lung disease on two liters of home oxygen at baseline presented to the emergency department with a two-week history of progressively worsening dysphagia. An initial chest X-ray showed concerns for bilateral pneumonia and aspiration. Initial laboratory results revealed anemia with a hemoglobin level of 6.9 g/dL. After receiving intravenous antibiotics and beginning transfusion of one unit of packed red blood cells, the patient went from being weak on examination to becoming lethargic, hypoxic, hypercapnic, hypertensive, and hypothermic due to flash pulmonary edema in the setting of a hypertensive emergency. Within only a few hours of being in the emergency department, the patient required transfer to the medical ICU; a prolonged hospital course ensued, eventually leading to a stable discharge, nearly three months later.