SANTA FE, NM – After a battery of laboratory tests, radiographic imaging, and subspecialty consultations, a team of health care professionals has formally diagnosed their medically complex patient as an acute on chronic hot mess.
“This was a very challenging case, and unfortunately, these type of cases are increasingly common nowadays,” said infectious diseases fellow Dr. Eloisa Dolina. “We may have a diagnosis now but that doesn’t make this particular patient’s outcome any better. We just know what we’re dealing with.”
The 59-year-old patient has a past medical history significant for everything: coronary artery disease s/p 47 stents and a septuple-vessel CABG; chronic respiratory failure secondary to end-stage interstitial lung disease on 4 liters nasal cannula; end stage liver disease complicated by hepatic encephalopathy, gastric and esophageal bleeding, ascites; end stage renal disease on hemodialysis; and metastatic cancer of unknown primary recently hospitalized for MRSA osteomyelitis of a sacral decubitus wound and bacteremia. He presented to the ER with fevers, chills, confusion, neck stiffness, chest pain, shortness of breath, abdominal pain, melena, and diffuse rash.
It took nearly two weeks of testing – none of which has come back normal by the way – but the primary team and the 32 subspecialists involved came up with the unifying diagnosis late yesterday evening.
“The patient meets all the criteria of an acute on chronic hot mess and then some,” explained critical care physician Dr. Grace Iconik, who has already taken care of the patient three times during this hospitalization in her ICU. “The differential diagnosis was finally whittled down to two: acute on chronic hot mess and acute on chronic train wreck. We settled on the former.”
