SHM Converge Scientific Abstract ePoster Gallery-Post-Embolization Syndrome: An Important Sepsis Mimicker to Be Aware Of

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This case report highlights post-embolization syndrome (PES) as an important and increasingly recognized sepsis mimic after interventional radiology procedures, especially catheter-directed embolization for renal angiomyolipoma (AML). PES is the most common complication of AML embolization, reported in about 54% of cases, though published rates vary widely. It typically presents 1–7 days after the procedure with fever and leukocytosis, and may also cause flank pain, nausea, vomiting, and sometimes paralytic ileus. Because these findings can resemble infection, PES can produce a systemic inflammatory response syndrome (SIRS) that is easily mistaken for sepsis.<br /><br />The report describes a 33-year-old woman, 6 days postpartum after an uncomplicated vaginal delivery, who came to the ED with acute flank pain and lightheadedness. She was hypotensive, tachycardic, febrile, and had leukocytosis. CT imaging revealed a large 21.5 cm right renal AML with active bleeding from a pseudoaneurysm and retroperitoneal hemorrhage. She underwent IR-guided embolization and was initially managed on the obstetric service.<br /><br />Over the next several days, she developed worsening tachycardia, persistent flank pain, fever, and leukocytosis, prompting transfer to hospital medicine and treatment with broad-spectrum antibiotics for presumed sepsis. However, repeat imaging showed no new hemorrhage or infectious complication, and cultures, viral testing, and echocardiography were unrevealing. After 72 hours of negative cultures and consultation with IR and urology, antibiotics were stopped and her presentation was determined to be most consistent with PES. Her fever and tachycardia gradually resolved, and she was discharged safely.<br /><br />The key lesson is that hospitalists should consider PES in the differential diagnosis of SIRS after embolization, since it is common, noninfectious, and may closely mimic sepsis.

Asset Subtitle

Oliver Bawmann

Meta Tag

Author List Julie Smith, Neelam Mistry, Oliver Bawmann

Category Clinical Vignettes

Concept Post-Embolization Syndrome

Concept Systemic Inflammatory Response Syndrome

Concept Sepsis

Concept Fever

Concept Leukocytosis

Distinguished Non-Finalist

Presenter Organization Department of Medicine, University of Colorado School of Medicine: Internal Medicine - Pediatrics Residency Program,

Presenting Author Oliver Bawmann

Track Adult

Keywords

post-embolization syndrome

renal angiomyolipoma

catheter-directed embolization

sepsis mimic

systemic inflammatory response syndrome

fever

leukocytosis

retroperitoneal hemorrhage

postpartum patient

interventional radiology

Post-Embolization Syndrome

Systemic Inflammatory Response Syndrome

Sepsis

Fever

Leukocytosis