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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dyspnea is an alarming symptom for both the patient and the emergency physician. There are many causes of dyspnea, some of which are life-threatening, especially in the elderly patient. In addition to the usual cardiac and pulmonary causes such as congestive heart failure, asthma exacerbation, COPD, pneumonia, and pulmonary embolism, there are less common causes of dyspnea, which if not diagnosed and managed expeditiously may have dire consequences for both the patient and physician. We present a case of an elderly patient with a life-threatening unusual cause of acute shortness of breath, a diaphragmatic hernia with sepsis.
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PMID:An unusual cause of dyspnea. 1679 52

A 32-year-old man who had undergone kidney transplantation presented with malaise, severe diarrhoea, nausea and vomiting, productive cough and shortness of breath. A 42-year-old woman with no relevant medical history presented with fever, weight loss and abdominal pain. Both patients had lactic acidosis and hypoglycaemia. Initially, the hyperlactataemia was thought to result from tissue hypoxia (sepsis) but it persisted after correction of the hypovolaemia; therefore, alternative causes were considered. Both patients were found to have T-cell lymphoma with liver infiltration. The male patient died before treatment could be initiated. The lactic acidosis resolved in the female patient following lymphoma treatment, but she died subsequently from the lymphoma. Lymphoreticular malignancies should be considered for cases of lactic acidosis with sufficient oxygen supply, particularly when hypoglycaemia is also present. The lactic acidosis and hypoglycaemia result from increased anaerobic glycolysis in tumour cells. Tumour reduction with chemotherapy can reduce the lactic acidosis.
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PMID:[Two patients with lactic acidosis and hypoglycaemia as initial presentation of a lymphoma]. 1722 91

Meticillin-resistant Staphylococcus aureus (MRSA), usually known as a nosocomial pathogen, has emerged as the predominant cause of skin and soft-tissue infections in many communities. Concurrent with the emergence of community-acquired MRSA (CA-MRSA), there have been increasing numbers of reports of community-acquired necrotising pneumonia in young patients and others without the classic health-care-associated risk factors. Community-onset necrotising pneumonia due to CA-MRSA is now recognised as an emerging clinical entity with distinctive clinical features and substantial morbidity and mortality. A viral prodrome (eg, influenza or influenza-like illness) followed by acute onset of shortness of breath, sepsis, and haemoptysis is the most frequent clinical presentation. The best treatment of this partly toxin-mediated disease has not been clearly defined. Whereas cases of CA-MRSA pneumonia have now been reported from almost every continent, the overall burden of disease of this emerging syndrome remains incompletely described. We report two related cases of community-onset pneumonia due to the MRSA USA300 genotype and review the literature regarding the emergence of CA-MRSA pneumonia.
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PMID:Emergence of community-acquired meticillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia. 1946 78

The mortality and morbidity of salmonella infections is seriously underestimated. Salmonella myocarditis is an unusual complication of salmonella sepsis in adults. Cases that do occur may be associated with high morbidity and mortality. We present a rare case of salmonella myocarditis with multi-organ failure in a previously healthy young adult man who was brought to the emergency room with fever, diarrhea, shortness of breath, and altered sensorium, discovered to have acute pulmonary edema and respiratory compromise for which he was assisted with mechanical ventilation for 8 days. Blood culture grew Salmonella typhi. Biochemically he exhibited myocardial, hepatic, and muscular enzymatic surge with renal failure, features of rhabdomyolysis, and disseminated intravascular coagulation. The patient showed a progressive improvement on treatment with ceftriaxone for 2 weeks in addition to decongestive therapy. He was discharged in good condition afterward.
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PMID:Salmonella myocarditis in a young adult patient presenting with acute pulmonary edema, rhabdomyolysis, and multi-organ failure. 1994 25

This article describes a case of a 26-year-old man presenting with left knee pain of 1 week's duration, fever, and acute onset of shortness of breath the day of admission. An arthrocentesis of the knee joint was grossly positive for methicillin-resistant Staphylococcus aureus. A left lower extremity venous duplex showed thrombosis of the superficial femoral, popliteal, posterior tibial, peroneal, and gastrocnemius veins. Pulmonary computed tomography-angiography was positive for acute pulmonary emboli. Initial management consisted of anticoagulation, intravenous antibiotics, and 2 arthroscopic irrigation and debridement procedures. After a normal transesophageal echocardiogram, a diagnosis of septic knee-induced deep venous thrombosis (DVT) of the left lower leg with subsequent septic pulmonary emboli was established. The patient was discharged to a long-term care facility for a 6-week monitored course of intravenous antibiotics. His DVT and pulmonary emboli were managed successfully with oral warfarin. Two months after his initial presentation, the patient returned with acute worsening knee pain. A knee arthrocentesis was unremarkable; however, radiographic imaging revealed fulminant osteomyelitis of the distal femur. He has since undergone open arthrotomy with excisional irrigation and debridement and is on a chronic oral antibiotic regimen. Sparse pediatric literature has shown an association between musculoskeletal sepsis and thrombosis. Only 1 case of septic knee-induced DVT exists in the adult literature, and it was not associated with pulmonary emboli. Our case provides evidence that DVT must be considered by the treating physician as a possible and devastating complication of septic arthritis.
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PMID:Septic knee-induced deep venous thrombosis in a young adult. 2095 53

CASE 1: A 65-year-old man underwent triple coronary artery bypass surgery. Postoperative atrial fibrillation lengthened his ICU stay. On postoperative day 6, it was noted that the platelet count, which had begun to rise from a postoperative nadir of 105,000, had fallen again to 90,000. The cardiologist indicated suspicion of heparin-induced thrombocytopenia (HIT); he stopped all heparin and ordered a heparin antibody test. Platelets were 98,000 the next day when the cardiologist wrote, "I am considering calling Hematology, but they would likely anticoagulate the patient; his stool guaiac is positive, so I will hold off consultation." The next morning, the patient had a pulseless, cool, and cyanotic right arm. On arrival, the hematologist found the patient confused, with a tender abdomen and absent bowel sounds. In spite of initiation of a direct thrombin inhibitor, the patient expired of bowel necrosis and sepsis within a few days. CASE 2: A 42-year-old physician with episodic supraventricular tachycardia had an outpatient ablation procedure. Two weeks later he presented with a swollen painful leg, with Doppler showing complete thrombotic occlusion of the common femoral, popliteal, and superficial femoral veins. Platelet count was 165,000 before procedure, 111,000 on representation, and 66,000 after intravenous heparin infusion was started. Shortness of breath and documented pulmonary embolus ensued. When a heparin antibody test ordered 5 days after admission came back very strongly positive, a direct thrombin inhibitor was begun. The patient demanded transfer to our hospital. His subsequent course was benign, including transition to warfarin and discontinuation of anticoagulants after 6 months.
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PMID:Heparin-induced thrombocytopenia in the cardiac patient: 10 points to help the physician. 2214 69

Pasteurella multocida is a Gram-negative rod that forms part of the natural oral flora of cats and dogs. It is usually associated with skin and soft tissue infections, as a result of bites and scratches. Although invasive and serious infections by P. multocida are rare, there are limited reports of pneumonia and sepsis. Infective endocarditis (IE) is extremely rare. The case is reported of an 82-year-old male who presented with a productive cough, fever, and shortness of breath, and who was initially diagnosed with pneumonia. Further work-up revealed P. multocida bacteremia and an aortic valve lesion consistent with endocarditis. The patient was treated with antibiotics, and showed significant clinical recovery on follow up.
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PMID:Pasteurella multocida endocarditis. 2264 64

A 15-year-old boy presented with signs of sepsis and a history of sore throat, fevers and shortness of breath. Full examination revealed an erythematous oropharynx and mild tonsillar swelling. He rapidly deteriorated requiring admission to intensive care. Blood cultures grew Fusobacterium necrophorum and an ultrasound scan performed for left neck tenderness confirmed internal jugular vein thrombosis. He was diagnosed with Lemierre's syndrome. This condition results from pharyngitis or tonsillitis with bacterial spread to the lateral pharyngeal space. Internal jugular vein thrombosis ensues with septic emboli and metastatic infections that most frequently involve the lungs. Although increasing in incidence, diagnosis is often delayed. We discuss why and describe its clinical presentation, investigations of choice and treatment strategies.
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PMID:Lemierre's syndrome: diagnosis in the emergency department. 2321 31

A 75-year-old woman presented 9 days post-total hip replacement with sudden onset of shortness of breath and fever. She had been discharged taking dabigatran. The patient was treated for sepsis with antibiotics and fluids. However, she deteriorated and was transferred to the intensive care unit. Following a 10 s asystolic episode the patient was thrombolysed with alteplase for presumed massive pulmonary embolism. Initially, her blood pressure and oxygen saturation improved. However, over the next few days, she remained persistently hypotensive. A CT scan of her chest, abdomen and pelvis demonstrated bilateral adrenal haemorrhages. A short synacthen test confirmed acute adrenal failure.
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PMID:Acute adrenal failure following anticoagulation with dabigatran after hip replacement and thrombolysis for massive pulmonary embolism. 2331 77

Alcohol abuse has been associated with an increased mortality and morbidity due to increased aspiration, delirium tremens, and seizures. The association of pneumococcal lung infections and leukopenia in the setting of alcohol abuse are rarely reported; however, when present, severe lung infections can happen with severe lung injury and poor response to conventional therapy and ultimately, death. We are reporting a case of 55-year-old-man presented with shortness of breath, cough and altered mental status and eventually found with severe pneumococcal lung infection in the setting of leukopenia and long-term alcohol abuse representing alcoholic leukopenic pneumococcal sepsis syndrome.
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PMID:Alcoholic leukopenic pneumococcal sepsis. 2393 Feb 44


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