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Heads up: don't forget the ordinary.

Eric R Gottlieb^1,2, Meghan M Nahass^1,2, Francis X Basile^1,3

¹Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.

Oxford Medical Case Reports

|January 31, 2019

Summary

A patient

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Area of Science:

Internal Medicine
Nephrology
Infectious Disease

Background:

A 72-year-old woman presented with severe anemia, shortness of breath, and a necrotic neck mass.
Initial presentation complicated by emergency department boarding and difficulty tolerating diagnostic imaging.

Observation:

The patient developed fevers, attributed to blood transfusion, but subsequently progressed to septic shock.
Septic shock led to disseminated intravascular coagulation and anuric renal failure requiring hemodialysis.

Findings:

Computed tomography (CT) scan revealed an obstructing ureteric stone as the source of infection.
The necrotic neck mass was initially misidentified as the cause of the patient's severe illness.

Implications:

This case highlights the critical importance of a broad differential diagnosis in complex medical presentations.
Accurate diagnosis is essential to guide appropriate treatment and prevent severe complications such as septic shock and renal failure.

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