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Sickle cell disease patients with fever and lung infiltrates often have infection, but pulmonary infarction is a possibility. Differentiating between pneumonia and infarction requires considering patient age, symptoms, and lab findings.
Area of Science:
- Hematology
- Pulmonology
- Infectious Diseases
Background:
- Sickle cell disease (SCD) presents unique challenges in diagnosing pulmonary complications.
- Fever and lung infiltrates in SCD patients are commonly attributed to infection, but other causes exist.
Purpose of the Study:
- To differentiate between infectious pneumonia and pulmonary infarction in patients with sickle cell disease.
- To identify clinical and laboratory features that distinguish these conditions.
Main Methods:
- Review of clinical presentations, imaging findings, and laboratory results in SCD patients with fever and lung infiltrates.
- Comparison of features between patients diagnosed with pneumonia versus pulmonary infarction.
Main Results:
- Pulmonary infarction can mimic pneumonia in SCD, even with negative cultures.
- Pneumonia is more common in younger patients (<5 years) with purulent sputum and upper lobe infiltrates.
- Thromboembolic disease is suggested by coexisting crisis, low leukocyte alkaline phosphatase, and microangiopathic changes.
Conclusions:
- Distinguishing pneumonia from pulmonary infarction in SCD requires careful evaluation of multiple factors.
- Fat embolism syndrome, secondary to bone marrow necrosis, is a recognized complication in SCD.
Abstract:
When a patient with sickle cell disease has fever and a lung infiltrate, usually it will be due to infection, even though cultures may be negative. However, pulmonary infarction can be virtually indistinguishable from pneumonia. Pneumonia is likely to be present in those younger than five years, with purulent sputum and upper lobe infiltrates. Coexisting crisis, a normal or low leukocyte alkaline phosphatase score and microangiopathic changes on peripheral blood smear favor thromboembolic disease. The fat embolism syndrome, caused by bone marrow necrosis and infarction, occurs in sickle cell disease.