A Complicated Case of Rheumatoid Arthritis in Septic Shock

Abstract

Sepsis is significantly associated with increased mortality among hospitalized patients. Patients can deteriorate rapidly, leading to septic shock (i.e., tissue hypoperfusion and organ dysfunction despite fluid resuscitation that can ultimately require a vasopressor). Patients immunocompromised from medical conditions such as rheumatoid arthritis with multiple joint arthroplasties are at a major risk of increased infections. Equally, medications that impair the immune system's normal function make this clinical case challenging. As noted in this case of a patient with a complex medical history and nontypical sepsis presentation, early intervention and a multidisciplinary approach to patient care is vital to patient improvement and survival during septic shock.

Impact of Treatment with Antioxidants as an Adjuvant to Standard Therapy in Patients with Septic Shock: Analysis of the Correlation between Cytokine Storm and Oxidative Stress and Therapeutic Effects

“…Several studies have demonstrated the involvement of proinflammatory cytokines in septic shock, and patients receiving standard treatment improve in intensive care units [76,77]; However, this response to treatment depends on the number of organs affected since admission [78] or if it was associated with surgical intervention, site of infection [79,80], burn [81,82], endocarditis [83,84], necrotizing fasciitis [85,86], meningitis [87,88], and septic arthritis [89][90][91]. The active participation of cytokines correlates with severity and prognosis [76].…”

Septic Shock: Management and Outcomes

“…While these signs are commonly present, they should not be required to define shock according to a statement from the European Society of Intensive Care Medicine (ESICM) consensus [ 16 , 17 ]. This is because septic shock has very variable signs and symptoms, depending on which system is affected [ 10 ], and it is associated with many conditions, such as surgical site infection [ 18 ], trauma [ 19 ], burn [ 20 ], endocarditis [ 21 ], necrotizing fasciitis [ 22 ], HIV [ 23 ], pancreatitis [ 24 ], meningitis [ 25 ], septic arthritis [ 26 ], and COVID-19 [ 27 ].…”