P0207 - Rapid Deterioration of a Patient with Septic Shock Secondary to Pancolitis: A Case Report

Nisha Nepal, MD¹, Mohammad A. Ahmed-Khan, MD^2
1Danbury Hospital, Danbury, CT; ²Danbury Hospital - Yale School of Medicine, Danbury, CT

Introduction: Fatal septic shock resulting from pancolitis after a routine colonoscopy is relatively rare. Here we report a case involving of a 66-year-old woman with a history of multiple myeloma-presented with feeling unwell just one day after a routine colonoscopy and was subsequently diagnosed with rapidly progressing septic shock and E. coli bacteremia.

Case Description/Methods: 66-year-old woman with history of multiple myeloma being treated with lenalidomide, dexamethasone, and monthly denosumab presented with poor oral intake, severe weakness and ongoing diarrhea just 1 day after her routine colonoscopy. Upon arrival to the hospital, she was found to be hypotensive with blood pressure in the 60s/40s and tachycardic with heart rate in the 140s, along with agonal breathing. She was intubated and had aggressive fluid resuscitation with 7 liters of normal saline and was started on phenylephrine and norepinephrine drips. Her urinalysis showed 2+ blood, protein, more than 10,000 bacteria. She also had AKI elevated BUN/creatinine ratio, lactic acidosis of 11, had low bicarbonate, potassium, calcium, and magnesium and pancytopenia (low white blood cell count 0.7K, hemoglobin of 6 gm/dl, and platelet count < 10K). She started on broad spectrum antibiotics. She also received 4 units packed RBCs, 2 units fresh frozen plasma and 2 units platelets. An urgent CT scan was performed, revealing pancolitis, potential early cholecystitis, and nonspecific bilateral perinephric stranding. Blood cultures obtained upon admission quickly grew Escherichia coli in all four bottles. The urine culture also indicated the presence of gram-negative rods, although the specific organism was not identified. The patient's condition continued to deteriorate. Blood pressure remained consistently low, and subsequent laboratory results demonstrated further decreases in hemoglobin and platelet count, even after transfusions. Given the rapid decline and the family's wishes, a decision was made to transition to comfort-focused care. The patient passed away a few hours later surrounded by her family at her bedside.

Discussion: In summary, while septic shock secondary to pancolitis following a routine elective colonoscopy is relatively rare, it is still possible, particularly in immunocompromised patients, likely due to bacterial translocation. The disease can progress rapidly and may lead to a fatal outcome if not promptly addressed. Despite aggressive management, the prognosis can be guarded, especially when neutropenia is present.


Disclosures:


Nisha Nepal, MD¹, Mohammad A. Ahmed-Khan, MD². P0207 - Rapid Deterioration of a Patient with Septic Shock Secondary to Pancolitis: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.