Acute Chest Syndrome with Vaso-occlusive Crisis in a Sickle Cell Disease Patient: A Mimic of Aspiration Pneumonia

REPORTon day 2 of admission requiring 15 L per minute oxygen to maintain saturation of 88%.She was shifted to the intensive care unit (ICU) in view of respiratory distress.Initial 2D echocardiography had shown right atrial and ventricular dilatation with mild tricuspid regurgitation and right ventricular systolic pressure (RVSP) of 49 mm Hg raising suspicion of pulmonary embolism.On further evaluation, pulmonary angiography did not show any embolus in the pulmonary artery, but high-resolution computerized tomography (HRCT) of the chest (Fig. 1) showed right lower lobar ground glass opacity (GGO).Noncontrast computerized tomography of the head did not reveal any abnormality.The patient was intubated and put on mechanical ventilation due to further deterioration in neurological status.Patient started on fentanyl and dexmedetomidine to maintain a Richmond agitation sedation score (RASS) of -1 to -2 to avoid desynchrony.The patient