A Young Man With Severe and Disabling Complications of Septic Shock

Abstract

M ost patients discharged from critical care, particularly after septic shock, experience problems with physical, psychosocial, and emotional functioning. We report on bilateral blindness and unilateral sensorineural hearing loss as rare but severely disabling complications in a young survivor of septic shock. Case ReportA 42-year-old man with a history of psoriatic arthritis, for which he used methotrexate (2.5 mg once a week), came to the emergency department with abdominal pain 2 days after endoscopic repair of an inguinal hernia on the left side. Laboratory examination revealed an elevated level of C-reactive protein (51 mg/L, reference value < 10 mg/L; to convert to nanomoles per liter, multiply by 9.524) and leukocytosis (13.9 x 10 9 /L; reference value, 4.0-10.0 x 10 9 /L), with an elevated level of neutrophils (12.6 x 10 9 /L; reference value, 1.3-5.7 x 10 9 /L) among others. Ultrasound showed a fluid collection in the abdominal wall, thought to indicate a rectus hematoma.The patient was admitted to the surgical care area for observation and analgesia, but clinical deterioration occurred and septic shock developed within 12 hours of admission. The patient was admitted to the intensive care unit (ICU) and resuscitated with fluids and vasopressors. Antibiotics (ceftriaxone and metronidazole) were administered to treat Abstract A young man had severe septic shock with multiorgan failure due to necrotizing fasciitis caused by group A streptococcus after endoscopic repair of a preperitoneal inguinal hernia. He was treated with surgical exploration and antibiotics and resuscitated with fluids, vasopressors, and inotropic agents. He survived this critical illness, but when he woke up from sedation, his vision was lost in both eyes. Ophthalmological evaluation revealed minimal peripapillary retinal hemorrhages without signs of papillary edema. Visually evoked potentials were negative. Magnetic resonance imaging did not show a cause of the visual damage. The patient had bilateral ischemic optic neuropathy diagnosed. Two weeks later, unilateral sudden deafness also developed. The acquired blindness and hearing loss were unchanged after more than 1 year and seem to be permanent, severely disabling this young survivor of septic shock. (American Journal of Critical Care. 2015;24:450-452) Cases of Note Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. a suspected abdominal infection and an emergency laparotomy was performed, which showed turbid fluid but no perforation or abscess. The mesh was removed and culture samples were taken. When cultures revealed hemolytic group A streptococcus, antibiotic treatment was swi...

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