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JOSE ORSINI, M.D., is Fellow, Division of Critical Care Medicine; ABHIJEET NADKARNI, M.D., is Fellow, Division of Critical Care Medicine; and JULIE CHEN, PHARM.D., is Critical Care Pharmacy Specialist, Division of Pharmacy, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY. NINA COHEN, PHARM.D., is Infectious Diseases Clinical Pharmacy Specialist, Divisions of Pharmacy and Infectious Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY.

Address correspondence to Dr. Orsini at the Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Gold Zone, 111 East 210th Street, Bronx, NY 10467-2490 (joseorsini{at}yahoo.com).

Purpose. A case of propofol infusion syndrome in a patient with respiratory failure and sepsis is reported. Summary. A 36-year-old Hispanic woman was admitted to the medical intensive care unit for treatment of respiratory failure and sepsis, likely secondary to pneumonia. Her medical history included human immunodeficiency virus infection and chronic hepatitis C virus infection. She was intubated and placed on mechanical ventilation. Empirical i.v. antimicrobial therapy was initiated with vancomycin, moxifloxacin, piperacillin–tazobactam, trimethoprim–sulfamethoxazole, and micafungin, along with corticosteroids and vasopressors. Propofol 1.5 mg/kg per hour i.v. and midazolam i.v. were initiated for sedation, but the dosages of both propofol and midazolam needed to be increased due to persistent agitation. On hospital day 7, the patient developed a morbilliform rash on her neck, shoulders, and chest and multiple abnormal laboratory test values, including elevated levels of alanine transaminase, aspartate transaminase, amylase, lipase, creatine kinase, and triglycerides. Serial electrocardiograms revealed sinus tachycardia. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration of the liver, no gallstones, and a normal pancreas. I.V. phenobarbital was added for sedation, and propofol was tapered and discontinued on the same day. The patient responded adequately to phenobarbital maintenance therapy and was eventually weaned off all other sedatives. The patient’s laboratory test values returned to normal within 72 hours after discontinuation of the propofol infusion, and the rash and tachycardia resolved. Conclusion. Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol. Index terms: Anesthetics; Antiinfective agents; Anxiolytics, sedatives and hypnotics; Dosage; Injections; Midazolam; Phenobarbital; Propofol; Respiratory insufficiency; Sepsis; Steroids, cortico-; Toxicity; Vasoconstricting agents