Propofol infusion syndrome complicated with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes: a case report

• Published in: Acute medicine & surgery Vol. 7; no. 1; pp. e473 - n/a
• Main Authors: Shimizu, Junji, Tabata, Takahisa, Tsujita, Yasuyuki, Yamane, Tetsunobu, Yamamoto, Yutaka, Tsukamoto, Takahito, Ogawa, Nobuhiro, Kim, Hyou, Urushitani, Makoto, Eguchi, Yutaka
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-01-2020; John Wiley and Sons Inc
• Subjects: Acidosis; Adenosine triphosphate; Case Report; Case Reports; Consciousness; Creatinine; Drug dosages; Laboratories; Magnetic resonance imaging; MELAS syndrome; Metabolism; mitochondrial disease; Mitochondrial DNA; Ostomy; Patients; propofol; propofol infusion syndrome; status epilepticus; Stroke; Ventilators; status epilepticus; propofol infusion syndrome; MELAS syndrome; propofol; mitochondrial disease
• DOI: 10.1002/ams2.473
• EISSN: 2052-8817

Background
Propofol infusion syndrome (PRIS) is a rare but lethal complication of propofol use. It has been suggested that the pathological mechanism of PRIS involves mitochondrial disorder caused by propofol.
Case Presentation
A 24‐year‐old woman who had been diagnosed with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes was admitted to our hospital with impaired consciousness and myoclonus. To control the non‐convulsive status epilepticus, propofol was administered. Arterial blood gas revealed metabolic acidosis, and creatinine kinase was elevated. The patient was diagnosed with PRIS. We treated her with interruption of propofol. She required mechanical ventilation for 25 days. After rehabilitation, she recovered and was discharged.
Conclusion
Mitochondrial disorder is a risk factor for PRIS. It is important for clinicians to be aware that mitochondrial disorder is a risk factor for PRIS, especially under conditions of critical illness and status epilepticus.
The pathological mechanisms of propofol infusion syndrome (PRIS) are similar to those of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes. Clinicians should be aware that mitochondrial disorder is a risk factor for PRIS, especially under conditions of critical illness.