Pseudosepsis: rectus sheath hematoma mimicking septic shock

Area of Science:

• Critical Care Medicine
• Sepsis Mimics
• Surgical Pathology

Background:

• Sepsis is a common critical care unit (CCU) diagnosis, but noninfectious disorders can mimic its presentation.
• Fever and leukocytosis are not exclusive to infection and frequently accompany various noninfectious conditions.

Observation:

• Hypotension with fever and leukocytosis often leads to a presumptive sepsis diagnosis.
• Clinicians must consider and rule out noninfectious causes of pseudosepsis after initiating empiric sepsis therapy.

Findings:

• Rectus sheath hematoma, a rare cause of pseudosepsis, can present as an acute surgical abdomen mimicking sepsis.
• Diagnosis involves imaging (ultrasound or CT scan) to identify the hematoma.
• Surgical drainage and ligation of bleeding vessels for rectus sheath hematoma rapidly reverses hypotension.

Implications:

• Rectus sheath hematoma should be considered in CCU patients with persistent hypotension unresponsive to standard treatments.
• Awareness of this rare condition is crucial for accurate diagnosis and effective management in critical care settings.