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A Curious Case of "Septic Shock"
Arjun Lakshman1, Charanpreet Singh1, Manphool Singhal2
1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
The Journal of Emergency Medicine
|November 6, 2016
Summary
Takayasu arteritis can cause shock-like symptoms mimicking refractory shock in the emergency department. Promptly checking peripheral pulses is crucial for accurate diagnosis and avoiding misdirected treatment.
Area of Science:
- Vascular Medicine
- Emergency Medicine
- Infectious Disease
Background:
- Takayasu arteritis, or pulseless disease, involves large artery occlusion, causing impalpable pulses and pseudohypotension.
- This condition can mislead emergency physicians managing patients with undiagnosed vascular occlusion.
Observation:
- A young woman presented with fever and shock unresponsive to fluid resuscitation.
- Initial diagnosis was severe vivax malaria, treated with artesunate and vasopressors.
- Examination revealed feeble upper limb pulses and palpable lower limb pulses.
Findings:
- Computed tomographic angiogram confirmed Takayasu arteritis as the cause of upper limb pulse deficits.
- The patient's hypotension mimicked refractory shock due to occlusive arterial disease.
Implications:
- Occlusive arterial disease in upper limbs can present as refractory shock in the emergency department.
- Emergency physicians must consider Takayasu arteritis in hypotensive patients with diminished upper limb pulses.
- Routine peripheral pulse examination is vital to prevent misdiagnosis and inappropriate interventions.
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