Description

A 56-year-old man with a known history of type 2 diabetes mellitus, hypertension, nephrolithiasis and gout presented with fatigue and flank pain for 3 days. The above symptoms were associated with fevers and chills. On admission, the patient’s vitals were remarkable for fever with maximum temperature (T max) 39.1°C, hypotension requiring pressor support and tachycardia. On auscultation, he had reduced air entry at lung bases, distended abdomen, bipedal oedema and petechial rash over the upper extremities and the trunks. In addition, there was purplish discolouration over the left medial sacral area. Laboratory work-up was remarkable for elevated white cell count 21.4x10⁹/L (4.0–12.0x10⁹/L), creatinine 7.98 mg/dL (0.60–1.40 mg/dL), anion gap of 25, erythrocyte sedimentation rate of 70 mm/hour (0–20 mm/hour), total bilirubin of 4.9 mg/dL (0.2–1.2 mg/dL) and lipase 422 U/L (0–140 U/L). Platelet count was 31×10³/µL (150–400 10³/µL), aspartate aminotransferase of 71 U/L (10–40 U/L) and alanine aminotransferase of 37 U/L (3–45 U/L). Septic shock was suspected, and the patient …