A rare case report of a saddle pulmonary embolism presenting with high grade fevers, responsive to anticoagulation

Abstract

Rationale: Pulmonary embolism can manifest by a myriad of clinical symptoms. High grade fever is a rare presentation of thromboembolic phenomenon.

Patient concerns: A middle aged woman presented with high grade fevers.

Diagnoses: Patient remained febrile despite broad spectrum antibiotics. All cultures were negative. CT angiogram of the chest was done, eliciting a large saddle embolus.

Interventions: Intravenous tissue plasminogen activator (t-PA) was administered and subsequently started on anticoagulation. Patient became afebrile 3 days after initiation of anticoagulation and all antibiotics were discontinued.

Outcomes: We demonstrate a case of a saddle pulmonary embolism presenting with high grade fevers that responded to anticoagulation.

Lessons: It is imperative to include pulmonary embolism in the differential diagnosis, when presented with high-grade fever in patients with unclear diagnosis.

Figure 1

Graphical representation of patient's fever curve in Celsius (y-axis) against time in days (x-axis).

Figure 2

CT angiogram of the chest showing saddle embolus in pulmonary arteries (marked with blue arrow). CT = computed tomography.

Figure 3

Gallium scan showing diffuse uptake in bilateral lungs.