Case Report
A 44 years old male a Tanzanian tourist first time hiking Mt
Kilimanjaro. He had no significant past medical history and had not used
any prophylaxis before hiking the mountain. On the 4thday of ascending on a route that takes six days to summit, at the height
of 4775m he developed severe difficulty in breathing. An initial
assessment done by the professional guide reported he was
breathlessness, having chest pain weak and had a low oxygen saturation
of 38% in room air. He was immediately kept on oxygen and rapid descent
was initiated by the guides using a customized single wheel canvas bed
to a level of 2300 meters where there was a standby ambulance which
shuttled him to a health facility. At the base of the mountain the
saturation raised to 83% on supplemental oxygen with a mild noted
improvement of the symptoms. No history of confusion, loss of
consciousness or fever that was reported.
At arrival to the hospital the patient was still dyspneic, afebrile and
on oxygen supplementation with saturation of 86 % in room air. When
titrating the oxygen level to five liters of oxygen on rebreather face
mask, saturation reached 98%. The rest of the vital signs were; BP-
130/77 mmHg, PR-103bpm, RR- 24 cycles/minute, T- 36.7ᴏC. Systemic examination of the chest revealed fine
crepitation at the mid zone and base of the lungs on bilateral
auscultation, other systems were essentially normal.
The investigations done were chest X-ray which showed bilateral lower
lobe infiltrates more on the left lung features suggestive of pulmonary
edema, Electrocardiogram (ECG) done showed sinus tachycardia, CBC showed
normal leukocyte count with hemoglobin of 12.9 g/dl, and hematocrit of
37%, D-dimer was raised to 8.5 UgFEU/ml other biochemistries including
Creatinine and Lipid profile were all normal however Covid-19 wasn’t
tested because it seemed unlikely. The patient was kept on oxygen and
was also initiated on Nifedipine 10mg per oral twice a day. The patient
was nursed in the ward.
On the 3rd day in the ward the patient was still
dyspneic and was still saturating at 91% in room air and 95% on 8
liters of oxygen. An ECG was done again and showed features of right
heart straining, an ECHO was done with normal findings, and chest CT
angiography was ordered and revealed a filling defect in the right upper
and bilateral lower lobe pulmonary arteries suggestive of pulmonary
embolism (Figure 01). The patient was initiated on low molecular heparin
(enoxaparin) 60mg subcutaneous twice a day for 5 days and remarkably
improved and was discharged after 4 days with warfarin 5mg per oral od
and He was instructed to come back to the health facility after 2 weeks
for follow up visit and checkup.