ACUTE CHEST SYNDROME AND CAVITARY PULMONA RY TUBERCULOSIS WITH SICKLE-CELL DISEASE

History and clinical findings: A 17-year-old girl from Zaire was admit ted to hospital with fever, cough, dyspnoea and severe chest pain. In addition to marked anaemia (haemoglobin 6.6 g/dl) she was known to hav e cavitary/exudative pulmonary tuberculosis (PTb) with bilateral basal infiltrations. Investigations: Blood gas analysis indicated partial r espiratory failure (pO(2) 55 mm Hg, pCO(2) 36 mm Hg). Blood smear unde r air exclusion showed erythrocyte sickling. Haemoglobin electrophores is demonstrated 92.7% HbS and thus confirmed sickle cell anaemia. A sm all spleen on sonography and the presence of Howell-lolly bodies were interpreted as signs of functional asplenia. Microbiological and radio logical tests confirmed exudative-cavitary PTb. Treatment and course T he findings were interpreted as due to an acute chest syndrome, caused by sickle cell thrombi in the pulmonary brood vessels, precipitated b y the PTb. Transfusion of two units of erythrocyte concentrates led to improvement of the chest pain and the respiratory failure within a fe w hours. The PTb was successfully treated without any complications. C onclusion: Acute chest syndrome is a vascular occlusive complication o f sickle cell disease, pulmonary tuberculosis precipitating the develo pment of this acute condition. Administration of erythrocyte concentra te rapidly improves the signs and symptoms.