CLARKSON’S SYNDROME – THE QUEST TO WHY

A 27 year old lady had been admitted under the care of Dr. Manali Bhattacharya (Consultant Medicine) and Dr. Rimita Dey (Senior Consultant & HOD Critical Care) with complaints of inability to passurine followed by lower abdominal discomfort. She had a history of Polyserositis (A serious inflammatory condition where multiple serous membranes (lining of body cavities like the heart, lungs, and abdomen) become inflamed and produce excess fluid (effusion), leading to symptoms like pain and breathlessness). On evaluation it was a suspected UTI (Urine Tract Infection) but at the break of dawn she had been shifted to the ICU due to extreme low blood pressure and difficulty breathing. Due to the previous history of Polyserositis, the family had been counselled accordingly. The lady began her silent battle for life as fluid was filling her lungs like water in a borewell while the best scientific minds of critical care and internal medicine were searching for the needle in the haystack. The family members held on to the last thread of hope and their trust gave the required impetus to cure the lady. A battery of investigations were advised and duly done, but the reports only led to roadblocks. In view of increasing hypoxia (A lack of oxygen reaching tissues), tachycardia (Fast heart rate) and tachypnea (Abnormally rapid breathing) the lady had been kept on high flow nasal oxygen. The consultants kept pushing through, shortlisting every possible clinical scenario, following protocols and Multi-Disciplnary Team (MDT) meetings. Finally, the answer had been the cytokine storm (A severe, potentially life-threatening immune reaction in which the body releases an excessive and uncontrolled amount of pro-inflammatory signaling proteins called cytokines into the blood). Although the body itself initiates this response to tackle the discomfort, its frankensteinian nature is what causes the damage. In this case, the cytokine storm had caused leakage in the blood vessels (capillaries), thus filling up her lungs with fluids. Post pleural fluid tapping and cytosorb absorption therapy (An extracorporeal blood purification method using special polymer beads in a filter to remove excess inflammatory mediators (cytokines) and toxins from the blood), the lady had improvement in vitals. She could breathe and her blood pressure had stabilised so she had been shifted from ICU to General ward where she had been in observation for another 48 hours. The family members had their prayers answered as they took home their dear one who had an unwavering love to live life at its fullest.