A Clinical Encounter With Pickwickian Syndrome

The clinical syndrome described in the literature as "Pickwickian syndrome" is characterized by a combination of sleep-disordered breathing, obesity, and daytime hypercapnia; the condition is also known as obesity hypoventilation syndrome (OHS). This syndrome is a diagnosis of exclusion after every other possible etiology is ruled out. Patients can present both with an exacerbation of or a chronic state of progressive dyspnea. In this report, we describe the case of a 62-year-old morbidly obese female with a BMI of 42 Kg/m2, who presented with progressively worsening breathlessness. An arterial blood gas (ABG) analysis revealed severe hypoxia with hypercarbia. A sleep study [polysomnography (PSG)] of the patient was performed, which revealed an apnea-hypopnea index (AHI) of 58.2, and the patient was diagnosed as having OHS after all other possible cardiorespiratory etiologies were ruled out. The patient was promptly managed with non-invasive ventilatory (NIV) support along with supportive management and was prescribed overnight NIV and subsequently discharged in stable condition.