HCA Florida Westside Hospital
hypertensive emergency, multiorgan failure
Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences
Introduction: Hypertensive emergency is defined as a systolic blood pressure greater than 180 mmHg or diastolic pressure over 120 mmHg with signs of end organ damage. The pathophysiology of a hypertensive emergency leads to an inability to maintain tissue perfusion resulting in organ hypoxia that often leads to temporary, and in more severe cases, permanent damage.
Case Description: A 27-year-old gentleman with no known past medical history presented with acute bilateral blurry vision, headache and bilateral lower extremity weakness for the past two days. His blood pressure was 266/169 and heart rate 99 beats per minute on presentation. Bloodwork demonstrated a creatinine level of 6.3 mg/dL, blood urea nitrogen 50 mg/dL, troponin I 0.466 ng/mL, hemoglobin 9.3 g/dL, platelet count 92,000/uL, low haptoglobin and elevated LDH levels. His platelet count was previously within normal limits. Schistocytes were noted on blood smear. His magnetic resonance imaging of the brain showed a 3 mm punctate acute ischemic infarct in the right parietal lobe. He was started on a nicardipine drip and transitioned to oral antihypertensives the following day. Renal function stabilized and he did not require renal replacement therapy. He was discharged on aspirin and a statin, as well as a blood pressure regimen of metoprolol tartrate, hydralazine, and nifedipine.
Discussion: This was a rare presentation of a young male with no past medical history who presented with microangiopathic hemolytic anemia and acute renal failure secondary to a hypertensive emergency. It stood out as the laboratory abnormalities were indicative of microthrombi formation in the systemic vasculature as a result of endothelial damage, similar to more commonly described pathologies such as TTP and HUS.
Gusan, Tatiana; Hong, Angelina; Kaufman, Sarah; and Zaher, Nathan, "Acute Multiorgan Failure in a 27-Year-Old Non-Drug User" (2023). East Florida Research Day 2023. 39.