SHM Converge Scientific Abstract ePoster Gallery-Catastrophe Loading and the Clock Is Ticking

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This case describes a 49-year-old woman with alcoholic cirrhosis and recent steroid/rituximab treatment for autoimmune hemolytic anemia who presented with vomiting, diarrhea, dysuria, and suprapubic discomfort. On arrival, she had tachycardia, elevated lactate, leukocytopenia with bandemia, thrombocytopenia, hyperbilirubinemia, and urinalysis findings suggestive of infection. CT imaging showed possible cystitis. She was initially admitted as having likely viral gastroenteritis and treated with IV fluids, while stool studies were ordered.<br /><br />Her condition worsened after admission. She became febrile, blood cultures were delayed, and empiric antibiotics were started only later. She then developed recurrent hypotension requiring vasopressors, with progressive worsening of leukopenia, renal function, acidosis, and liver tests. Blood cultures ultimately grew Escherichia coli, but despite broad-spectrum antibiotics, stress-dose steroids, and escalating pressor support, she progressed to septic shock, multiorgan failure, and death.<br /><br />The case highlights several diagnostic failures: anchoring bias toward a gastrointestinal diagnosis despite urinary symptoms and sepsis indicators; incomplete medication history, including unclear ongoing steroid use; failure of the overnight team to reassess the patient after fever and recognize sepsis; and delayed ordering of blood cultures. The authors emphasize that earlier recognition of sepsis might have changed the outcome.<br /><br />In response, the institution is strengthening sepsis care through a sepsis committee and updated best practice advisories that classify patients into sepsis watch, severe sepsis, and septic shock pathways. These include evidence-based diagnostic and treatment steps, along with ongoing compliance monitoring and staff education. The case underscores the importance of leadership, multidisciplinary teamwork, and diagnostic excellence initiatives to improve early recognition and management of sepsis.

Asset Subtitle

Sandhya Tagaram

Meta Tag

Author List Aida Taku, Jorgjeta Bukli, Katie E. Raffel, Sandhya Tagaram

Category Clinical Vignettes

Concept Sepsis

Concept Septic Shock

Concept Organ Dysfunction

Concept Anchoring Bias

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization UMass Memorial Medical Center

Presenting Author Sandhya Tagaram

Track Adult

Keywords

septic shock

Escherichia coli bacteremia

sepsis

alcoholic cirrhosis

autoimmune hemolytic anemia

rituximab

steroid therapy

urinary tract infection

diagnostic error

multiorgan failure

Sepsis

Septic Shock

Organ Dysfunction

Anchoring Bias

Blood Culture