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Pseudosepsis: rectus sheath hematoma mimicking septic shock [Case Report]

Hamid, Naveed S; Spadafora, Philip F; Khalife, Michael E; Cunha, Burke A
There are many noninfectious disorders in the critical care unit (CCU) that mimic sepsis. Pseudosepsis is the term applied to noninfectious disorders that mimic sepsis. Fever/leukocytosis is not diagnostic of infection but frequently accompanies a wide variety of noninfectious disorders. When fever/leukocytosis and hypotension are present, sepsis is the presumptive diagnosis until proven otherwise. After empiric therapy for sepsis is initiated, the clinician should rule out the noninfectious causes of pseudosepsis. The most common causes of pseudosepsis in the CCU setting are pulmonary embolism, myocardial infarction, gastrointestinal hemorrhage, overzealous diuretic therapy, acute pancreatitis, relative adrenal insufficiency, and (rarely) rectus sheath hematoma. Rectus sheath hematoma may occur secondary to trauma/anticoagulation therapy and may present as an acute surgical abdomen mimicking sepsis. Rectus sheath hematoma should be considered when other causes of pseudosepsis or sepsis fail to explain persistent hypotension unresponsive to fluids/pressors. The diagnosis of rectus sheath hematoma is by abdominal ultrasound or computed tomography scan. If the abdominal computed tomography scan is negative for other intra-abdominal pathology and other causes of pseudosepsis are eliminated, then the diagnosis of pseudosepsis caused by rectus sheath hematoma is confirmed by demonstrating a hematoma in the rectus sheath. Treatment of rectus sheath hematoma is surgical drainage and ligation of any bleeding vessels. Evacuation of the rectus sheath hematoma rapidly reverses the patient's hypotension and is curative. We describe a case of pseudosepsis caused by rectus sheath hematoma in an elderly man with hypotension unresponsive to fluids/pressors and mimicking septic shock. Clinicians should be aware that rectus sheath hematoma is a rare but important cause of pseudosepsis in patients in the CCU.
PMID: 17137947
ISSN: 0147-9563
CID: 3435602

Fulminant hepatic failure

Chapter by: Tripodi, Joseph; Spadafora, Philip; Bernstein, David
in: Infectious diseases in critical care medicine by Cunha, Burke A (Ed)
New York : M. Dekker, 1998
pp. 645-655
ISBN: 9780824701147
CID: 3575372

Streptococcus bovis endocarditis and vertebral osteomyelitis [Case Report]

Spadafora, P F; Qadir, M T; Cunha, B A
Streptococcus bovis recovered from blood cultures may represent bacteremia alone, bacteremia from an extravascular source, or endocarditis. Patients with S. bovis endocarditis frequently have a gastrointestinal focus. S. bovis has been associated with many gastrointestinal diseases and in particular with colon carcinoma. S. bovis endocarditis may be complicated by embolic events or osteomyelitis. Vertebral osteomyelitis is a rare complication of S. bovis endocarditis. We report the third known case of S. bovis endocarditis with vertebral osteomyelitis.
PMID: 8682689
ISSN: 0147-9563
CID: 3437612

Myonecrosis due to Clostridium septicum in a patient with unexplained neutropenia: successful treatment with granulocyte colony-stimulating factor [Case Report]

Vogel, C; Spadafora, P; Horowitz, B; Staszewski, H; Turi, G K
We report a case of sepsis due to Clostridium septicum successfully treated with granulocyte colony-stimulating factor (GCSF). This case prompted our review of clostridial sepsis and considerations regarding the use of GCSF in cases of drug-induced neutropenia.
PMID: 7541162
ISSN: 0038-4348
CID: 3276482