Page 97 - GTM-3-1

Global Translational Medicine

CASE REPORT
Carbon monoxide poisoning manifesting with

rhabdomyolysis, Takotsubo syndrome, and skin
lesion: A case report

2†
1†
Damiano Cardinale *, Edoardo Pennacchio , and Marco Russo 1
1 Unit of Cardiology, Sacro Cuore di Gesù Hospital, Gallipoli (Lecce), Italy
2 Emergency Medicine Unit, San Carlo Hospital, Potenza, Italy

Abstract
Carbon monoxide (CO) poisoning is characterized by non-specific and protean clinical
manifestations, exhibiting a highly variable presentation. We present a case of an
83-year-old female Alzheimer’s patient, a non-smoker, who was found unconscious in
her wheelchair by her caregiver at home. The heating in the apartment was powered
by liquefied petroleum gas. On admission to the emergency department, her vital
signs were normal, but she was unconscious and slightly dyspneic. The examination
revealed red-colored skin lesions in the submammary area, where the wheelchair
safety belt was firmly fastened. The rest of the physical examination results were
unremarkable. The carboxyhemoglobin level was 23%, and there was an increase
in creatine phosphokinase and troponin I levels. On the 2 day of hospitalization
nd
in the emergency ward, the electrocardiogram revealed negative T waves in the
† These authors contributed equally V1–V6 leads, while the bedside echocardiogram revealed apical ballooning of
to this work
the left ventricle. The myocardial perfusion examination yielded a negative result
*Corresponding author: for myocardial ischemia. In the management of patients with CO poisoning, it is
Damiano Cardinale
(damiano.cardinale@asl.lecce.it) important for emergency physicians to assess the presence of multiple organ and
tissue disorders. Consequently, the patient was diagnosed with CO poisoning with
Citation: Cardinale D, Pennacchio
E, Russo M. Carbon monoxide skin, skeletal, and cardiac muscle involvement.
poisoning manifesting with
rhabdomyolysis, Takotsubo
syndrome, and skin lesion: A Keywords: Carbon monoxide poisoning; Rhabdomyolysis; Takotsubo syndrome
case report. Global Transl Med.
2024;3(1):1718.
https://doi.org/10.36922/gtm.1718
Received: August 30, 2023 1. Background
Accepted: January 4, 2024
Published Online: March 20, 2024 Carbon monoxide (CO) is an odorless, colorless, and tasteless gas produced by the incomplete
Copyright: © 2024 Author(s). combustion of organic substances. More than 20,000 emergency department visits/year are
This is an Open-Access article related to CO poisoning; the worldwide cumulative incidence and mortality are currently
distributed under the terms of the
Creative Commons Attribution estimated at 137 cases and 4.6 deaths per million, respectively. Carbon monoxide binds to
License, permitting distribution, hemoglobin (forming carboxyhemoglobin [COHb]) with an affinity nearly 200-fold higher
and reproduction in any medium,
provided the original work is than oxygen (O ). As a result, hemoglobin becomes less efficient at delivering O to the cells,
2
2
properly cited. ultimately causing intracellular hypoxia. Elevated COHb blood levels (over 5% in non-smokers
1,2
Publisher’s Note: AccScience and 10% in smokers) suggest external exposure to CO. The brain and the myocardium are
Publishing remains neutral with constantly involved in CO poisoning due to their high levels of O consumption. The clinical
regard to jurisdictional claims in 2
published maps and institutional symptoms of CO poisoning are non-specific and can lead to diagnostic uncertainty. The most
affiliations. frequently reported acute symptoms of CO poisoning are headache, dizziness, weakness,
Volume 3 Issue 1 (2024) 1 https://doi.org/10.36922/gtm.1718