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Unusual presentation of more common disease/injury
CASE REPORT
Massive pulmonary embolism presenting initially as acute psychosis
  1. Michael Lawrenz Ferreras Co1,
  2. Arianne Clare Agdamag1,
  3. Marcus Juan Esteban1 and
  4. Roselyn Mateo1,2
  1. 1 Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
  2. 2 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Michael Lawrenz Ferreras Co, michaellawrenzco{at}gmail.com

Abstract

This is a case of a 68-year-old man with Parkinson’s disease who was admitted in the psychiatry floor for new-onset aggressive behaviour and hallucinations. On the third day of hospitalisation, he suddenly developed dyspnoea followed by an ECG showing atrial fibrillation with rapid ventricular response. A few seconds later, he went into cardiac arrest; he was resuscitated after multiple rounds of Advanced Cardiovascular Life Support. A transthoracic echo showed hypokinetic and enlarged right ventricle. A CT Chest showed a saddle embolus. Patient was provided with systemic thrombolysis, which led to an improvement in his haemodynamic status. Interestingly, his psychotic symptoms also improved. In this paper, we present and review how pulmonary embolism can be associated with acute psychosis.

  • delirium
  • psychotic disorders (INCL schizophrenia)
  • pulmonary embolism

https://doi.org/10.1136/bcr-2017-222018

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    Footnotes

    • Twitter @MichaelCoMD

    • Contributors MLFC is the primary author for this case report. He was the one who directly cared for the patient while he was admitted. He also wrote the case and the hospital course of the patient. ACA and MJE did most of the literature review for this case. They read previous case reports and other relevant literature for this case. They were the ones who wrote the discussion part. RM was our attending who edited and commented on our draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.