Negative pressure pulmonary oedema due to rigors and chills associated with liver abscess

Abstract

A 61‐year‐old male presented with progressive generalized weakness, myalgia, diaphoresis, fever, episodic chills and rigors that had started 4 days previously. Chest x‐ray (CXR) showed overlying curvilinear radio‐opacities. Abdominal computed tomography revealed liver and bilateral adrenal lesions. Empiric 7‐day intravenous Piperacillin / Tazobactam (Zosyn) was initiated, and he was admitted for sepsis. After an episode of rigors on Day 2, he developed acute hypoxic respiratory failure with inspiratory stridor. CXR revealed new, bilateral airspace disease. Racemic Epinephrine, Solumedrol, Ketorolac (Toradol) and Diphenhydramine were given, and he was transferred to the intensive care unit with presumptive diagnosis of foreign body aspiration or allergic reaction. With each subsequent episode of rigor and chills, he continued developing hypoxic respiratory failure with stridor and an incremental increase in pulmonary oedema on imaging. Pulmonologist concluded it likely secondary to negative pressure pulmonary oedema caused by transient laryngeal dyskinesia induced by the increased work of breathing associated with rigors. Symptoms resolved after the complete course of antibiotics along with supportive therapy.

Negative pressure pulmonary edema (Review)

“…Most cases in children are subglottic obstructions caused by the glottis, acute infectious croup or epiglottitis (28,29). In these pediatric cases, patients who present with ventilatory failure due to glottic or supraglottic obstruction with prolonged stridor (30) and pulmonary edema are usually diagnosed after the initiation of mechanical ventilation. Chronic airway obstruction.…”