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A 56-year-old African American woman with hemoglobin SC disease, hypertension, and diabetes mellitus presented to the emergency department after she was found unresponsive at home. The patient was last seen normal approximately 8 hours prior to presentation. According to family, she complained of severe arthralgias in her hands and knees for the prior 2 days. Physical examination revealed an obese woman who was unresponsive to verbal stimulus. Blood pressure was 130/70 mm Hg, heart rate was 103 beats per minute, and respirations were 18 per minute and labored. Lung examination revealed diffuse wheezes and decreased breath sounds over the left-upper lobe. On neurologic examination, the patient's brainstem reflexes were intact; her tone and bulk were normal; and equal, purposeless movements were noted in all limbs. She flexed only her upper extremities to painful stimuli.
A complete blood count showed a leukocytosis of 22.0 K/μL and hemoglobin of 9.4 g/dL. A chest X-ray film showed hazy opacification of the left hemithorax with an area of confluent density in the left upper lung suggestive of an infiltrate and …
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