Polymicrobial Septic Shock with Multiorgan Dysfunction in an Otherwise Healthy Immunocompetent Patient

Abstract

Background: Sepsis is a significant cause of morbidity and mortality worldwide despite advanced critical life-support. Septic shock and multiorgan dysfunction is the terminal stage in critically ill patients leading to perfusion abnormalities, lactic acidosis, oliguria and altered mental status creating a rapid downhill course and mortality. Sepsis ensues through stages of exaggerated immune response including systemic inflammatory response syndrome, in the backdrop of infectious stimuli.Case report: Polymicrobial septic shock with multiorgan dysfunction leads to demise in an otherwise healthy immunocompetent patient. Microbiological profile revealed Escherichia coli urinary tract infection (UTI), Staphylococcus sciuri bacteremia, Acinetobacter baumanii ventilator-associated pneumonia, and central line catheter tip Pseudomonas aeruginosa, thereby pointing towards polymicrobial sepsis. Neutropenia of 290/ dL along with serum procalcitonin 5 ng/mL was detected. An autopsy revealed anasarca, bilateral lung abscesses, Hepatosplenomegaly, intracerebral hemorrhage, consolidated lungs, myocardial hypertrophy, and acute tubular necrosis were observed. Bacterial colonies from lungs, liver and cerebrospinal fluid grew Pseudomonas aeruginosa. Conclusion:Polymicrobial sepsis can rapidly deteriorate a patient and mandate aggressive fluid, inotrope, ventilation, and antimicrobial therapy, notwithstanding challenges in diagnosis, prognosis and optimal management.