DELAYED TREATMENT OF DECOMPRESSION SICKNESS TYPE II RESPONSIVE TO HYPERBARIC OXYGEN

Abstract

A 38-years-old recreational female diver presented at our hospital with fatigue, dizziness, cutis marmorata, swollen and painful ankles, back pain and pulmonary symptoms. The patient was diving in the Maldives, with series of daily dives mostly around 22m, each dive decompression made on 6m with duration of 3 minutes. After more than 30 hours from her last dive, she took an international flight Maldives – North Macedonia that lasted for about 12 hours. Her first checkup was more than 80 hours of the onset of symptoms. Neurological examination, electrocardiogram, chest X-ray and lung ultrasound were normal. Laboratory data only showed evidence of thrombocytopenia and elevated D-dimer. Decompression sickness type II was diagnosed according to history and physical examination. Recompression treatment with hyperbaric oxygen (HBO2) was immediately started (2.8 ATA on 100% oxygen over a period of 90 minutes) and additional session at the same day with a duration of 70 minutes to 2.4 ATA. Additional courses with HBO2 were required daily in the next 7 days to 2.4 ATA. The most of the patient’s symptoms were resolved after the third therapy with HBO2, and the cough after the 7th therapy. The patient was released from hospital after resolution of the symptoms. Conclusion: Cutis marmorata is often associated with more serious manifestations of decompression sickness. Treatment with HBO2 is the cornerstone therapy for DCS. Indeed, treatment with hyperbaric oxygen can be successful even in cases with delayed start.