Sickle cell crises are commonly treated at our institution given its large sickle cell patient population and well-established hematology department. While pain management is a crucial aspect to these patients' care, it is important to remember that a vasa-occlusive crisis can be life threatening. Many organs can be at risk, including the lungs (acute chest syndrome), brain (stroke), eyes (retinopathy) and as in our case, the liver. We hope this case report can become incorporated in future differential diagnoses pertaining to sickle cell crises.

Case Presentation

A 48-year-old black female with a past medical history of sickle cell anemia, HIV on antiretroviral therapy, pulmonary hypertension on 4L of home oxygen, lymphocytic interstitial pneumonitis, chronic obstructive pulmonary disease, remote history of deep vein thrombosis, and pulmonary embolism, presented to the emergency department with complaints of shortness of breath, increased abdominal girth and lower extremity swelling for four days. She also complained of lower back and leg pain typical of her sickle cell crises. Her prescribed medications included tenofovir/emtricitabine, atazanavir, ritonavir, folic acid, oxycodone/acetaminophen, oral hydromorphone, and furosemide. Her social history was significant for smoking one fourth of a pack of cigarettes daily.