Genç ve Sağlıklı Bir Boyacıda Şiddetli Anemi İle Seyreden ARDS Yönetimi, Nadir Bir Olgu
Özet
Kimyasal inhalasyona bağlı akut solunum sıkıntısı sendromu (ARDS) nadir görülen ancak yaşamı tehdit eden bir durumdur. Şiddetli anemi ile eşzamanlı görülmesi ise daha da nadirdir ve tanı-tedavi sürecinde ek zorluklar yaratır. On dokuz yaşında, öncesinde bilinen hastalığı olmayan erkek hasta, göğüs ağrısı, öksürük ve nefes darlığı şikayetleriyle başvurdu. Oda havasında SpO₂ %70, solunum sayısı 35/dk, nabız 130/dk idi. Kan gazında şiddetli hipoksemi (pO₂ 57,9 mmHg), hemogramda belirgin anemi (Hb 5,6 g/dL) saptandı. Toraks BT’de bilateral multilober buzlu cam opasiteleri görüldü. Enfeksiyon, otoimmün hastalık ve hematolojik malignite gibi olası nedenler dışlandı. Hastanın, yakın zamanda kapalı ve yetersiz havalandırılan ortamda boya tineri ve solvent (BTEX bileşikleri) ile çalıştığı öğrenildi. Hasta yüksek akım oksijen, non-invaziv mekanik ventilasyon, kortikosteroid, antibiyotik ve transfüzyon desteği ile tedavi edildi. Klinik durumu kademeli olarak düzeldi ve taburcu edildi. Mesleki ortamda yüksek konsantrasyonda organik çözücü inhalasyonu, sağlıklı genç bireylerde dahi hızlı başlangıçlı ARDS ve ağır anemiye yol açabilir. Mesleki maruziyet öyküsünün erken sorgulanması, hızlı destek tedavisinin başlanması ve multidisipliner yaklaşım, olumlu sonuçlar için kritik öneme sahiptir.
Acute respiratory distress syndrome (ARDS) due to chemical inhalation is a rare but life-threatening condition. Its simultaneous occurrence with severe anemia is even more uncommon and presents additional challenges in diagnosis and management. A 19-year-old male with no known prior medical history presented with chest pain, cough, and shortness of breath. His SpO₂ was 70% in the room air, respiratory rate 35/min, and heart rate 130/min. Arterial blood gas analysis revealed severe hypoxemia (pO₂ 57.9 mmHg), and complete blood count showed marked anemia (Hb 5.6 g/dL). Chest CT demonstrated bilateral multilobar ground-glass opacities. Potential causes such as infection, autoimmune disease, and hematologic malignancy were excluded. The patient reported recent work in a poorly ventilated space with exposure to paint thinner and solvent (BTEX compounds). He was treated with high-flow oxygen, noninvasive mechanical ventilation, corticosteroids, antibiotics, and blood transfusion support. His clinical condition gradually improved, and he was discharged. Occupational exposure to high concentrations of organic solvents can cause rapid-onset ARDS and severe anemia even in healthy young individuals. Early inquiry into occupational history, prompt initiation of supportive therapy, and a multidisciplinary approach are critical for favorable outcomes.
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