THE ACUTE CHEST SYNDROME OF SICKLE-CELL DISEASE

The acute chest syndrome (ACS), characterized by fever, chest pain, le ukocytosis and a new infiltrate on chest roentgenogram, is a common co mplication of sickle hemoglobinopathies. The major differential diagno ses of ACS are pneumonia and pulmonary vaso occlusive disease, which m ay occur simultaneously. Bacterial pulmonary infections are documented infrequently in ACS with the exception being in the pediatric populat ion under 5 years of age. Because there are no clinical or laboratory parameters that clearly allow for distinction between pneumonia and va soocclusive disease, empiric use of antibiotics directed against S. pn eumoniae and other pathogens commonly seen in community-acquired pneum onias remain a mainstay of therapy.