History

A 69-year-old right-handed man with a history of substance use disorder, hypertension, and diabetes presented to the emergency department in an unresponsive state. Upon examination, apart from tachycardia (heart rate, 108 beats per minute), vital signs were within normal ranges (blood pressure, 134/102 mm Hg; temperature, 97.9 ºF (36.6 ºC); respiratory rate, 16 per minute; oxygen saturation, 96%). The patient had a Glasgow coma scale score of 8. Otherwise, the physical examination revealed no abnormalities. Prior psychiatric and surgical histories were unremarkable. There was no history of recent travel, camping, hiking, or vaccination. No family history could be obtained.

Laboratory work-up revealed an elevated creatine kinase level (49 006 U/L [818.4 μkat/L]; normal reference range, 10–205 U/L [0.17–3.42 μkat/L]). An electrocardiogram showed sinus tachycardia without evidence of cardiac ischemia. An echocardiogram was unremarkable. Alanine aminotransferase (126 U/L [2.10 μkat/L]; normal reference range, 0–40 U/L [0–0.67 μkat/L]) and aspartate aminotransferase (488 U/L [8.15 μkat/L]; normal reference range, 3–44 U/L [0.05–0.74 μkat/L]) levels were elevated. Polymerase chain reaction results were negative for HIV-1, HIV-2, syphilis treponemal, and COVID-19 antibodies. The remaining routine laboratory work-up findings were within normal limits. Urine drug screening was positive for cocaine, marijuana, fentanyl, and benzodiazepines.

Naloxone was administered, but the patient remained unresponsive. Intubation was performed for airway protection. Noncontrast and contrast-enhanced CT of the head and CT angiography were performed in the emergency department to rule out an acute intracranial abnormality. Multisequence MRI of the brain with administration of intravenous contrast material was ordered for further assessment. CT of the abdomen and pelvis was unremarkable (images not shown).

中文翻译：

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病例 324：CHANTER 综合症

 历史

一名 69 岁的右撇子男子有物质使用障碍、高血压和糖尿病病史，在急诊室就诊时已失去知觉。经检查，除了心动过速（心率，每分钟 108 次）外，生命体征均在正常范围内（血压，134/102 mm Hg；体温，97.9 ºF (36.6 ºC)；呼吸频率，每分钟 16 次；血氧饱和度，96%）。该患者的格拉斯哥昏迷量表评分为8分。除此之外，体检未发现异常。之前的精神病史和手术史并无异常。近期没有旅行、露营、徒步旅行或疫苗接种史。无法获得家族史。

实验室检查显示肌酸激酶水平升高（49 006 U/L [818.4 μkat/L]；正常参考范围，10–205 U/L [0.17–3.42 μkat/L]）。心电图显示窦性心动过速，但没有心脏缺血的证据。超声心动图未见异常。丙氨酸转氨酶（126 U/L [2.10 μkat/L]；正常参考范围，0–40 U/L [0–0.67 μkat/L]）和天冬氨酸转氨酶（488 U/L [8.15 μkat/L]；正常参考范围范围内，3–44 U/L [0.05–0.74 μkat/L]）水平升高。 HIV-1、HIV-2、梅毒螺旋体和 COVID-19 抗体的聚合酶链反应结果呈阴性。其余常规实验室检查结果均在正常范围内。尿液药物筛查结果显示可卡因、大麻、芬太尼和苯二氮卓类药物呈阳性。

给予纳洛酮，但患者仍然没有反应。进行插管以保护呼吸道。在急诊室进行了头部平扫和增强 CT 以及 CT 血管造影，以排除急性颅内异常。要求进行脑部多序列 MRI 并静脉注射造影剂以进行进一步评估。腹部和骨盆 CT 未见异常（图像未显示）。