CHEST Guidelines-A-Middle-Aged-Woman-With-Hematochezia,-Hypotension (1)

A-Middle-Aged-Woman-With-Hematochezia,-Hypotension (1)

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The document details a medical case study of a 57-year-old woman who presented to the emergency department with symptoms including vomiting, hematochezia (bleeding per rectum), hypotension, and leg cramps. This patient had a history of mantle cell lymphoma and had recently undergone chemotherapy. On arrival, her vital signs indicated severe hypotension and tachycardia, with a low hematocrit level and a high potassium level. Despite fluid resuscitation and improvement in hemoglobin, she remained hypotensive, suggesting septic shock due to neutropenia. <br /><br />Broad-spectrum antibiotics and vasopressors were administered, stabilizing her blood pressure. Subsequent imaging revealed gas in abdominal and pelvic regions and within the musculature, leading to a diagnosis of spontaneous gas gangrene, specifically caused by Clostridium septicum. This condition is characterized by acute onset muscle pain, swelling, and systemic toxicity, often misdiagnosed due to its rapid progression and high mortality rate (67-100% within 24 hours). <br /><br />The patient's condition worsened, evidenced by a rising serum lactate level, and she eventually suffered cardiac arrest and died, despite resuscitative efforts. Blood cultures later confirmed C. septicum as the causative agent. <br /><br />This case underscores the critical nature of early diagnosis and treatment in spontaneous gas gangrene, which involves surgical debridement and antibiotics. The article also highlights the importance of recognizing predisposing factors like neutropenia, lymphoproliferative disorders, or recent chemotherapy, which can signal heightened risk for such infections. The study calls for prompt clinical awareness to improve outcomes in such high-risk patients.

Keywords

medical case study

spontaneous gas gangrene

Clostridium septicum

neutropenia

chemotherapy

septic shock

broad-spectrum antibiotics

mantle cell lymphoma

emergency department

high-risk patients